Steele Memorial Medical Center

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Hospital (208) 756-5600 Clinic (208) 756-6212

Delivering Compassionate Healthcare

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Anticoagulation Clinic
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Plastic & Reconstructive Surgery

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Respiratory Therapy and Pulmonary Rehabilitation
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Candidate Referral Form

Home > Careers > SMMC Employee Referral Program > Candidate Referral Form

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Candidate Referral Form

Applying Candidate's Information

Name of Candidate

Phone Number of Candidate

Position Applied For

Referring Candidate's Information

Legal Name of Referrer

Date of Referral

Phone Number of Referrer

Last Four of Social Security Number

Mailing Address

"I have read and understand the Referral Program Rules." (Sign below to digitally authorize).

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Hospital
203 S. Daisy Street
Salmon, Idaho 83467
(208) 756-5600

Clinic
103 S. Daisy Street
Salmon, Idaho 83467
208-756-6212

Specialty Clinic
805 Main Street
Salmon, Idaho 83467
208-756-5666