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staffing for the dental professional

Please fill out our Employment Application
Email Address:
Name:  
Address:
Phone:
City/State/Zip:
Pager/Cell: Additional phone:
Type of position you are interested in?
 Temporary Permanent
Education Completed:
Years of Experience:
What days are you available?
Monday Tuesday Wednesday Thursday
Friday Saturday Sunday 		Have you had experience in the speciality fields?
Perio Endo Oral Surgery
Pedo Ortho Prostho
Please tell us your hourly rate : $ I am a:

Are you willing to Travel? Yes No
How far?

State or National Certification

X-Ray License

Please list 2 recent dental employers that can be checked for references by this agency:

 Name
Phone
Name
Phone
Do You:  
Take X-Rays Develop X-Rays
Mount X-Rays Four-Handed Chairside
Mix Alignate Take Impressions
Pour Dental Impressions

Trim Models Make
Operate Autoclave Operate Dryclave
Ultrasonic Operate a Computer
Schedule Appointments Computer Program
OSHA Prescribed Sterilization Disinfection
Post Operative Instructions
Oral Hygiene Instructions
Soft Tissue Management
Know how to chart Perio chart
Fill out Insurance Forms
Additional information: