Secure Online Employment Application for Dental Practices

Please fill out the form below and upload your resume. We will be contacting you soon for an interview if you have properly completed the form. Thank you.

Date of Application*

First Name*

Last Name*

Phone Number*

Email Address*

City of Residence*

Describe prior experience in a dental office.*

Are you a DA, RDA, RDH ?*

Select

Would you like to be trained as a dental assistant*

Select

How comfortable are you using computers?*

Select or enter value

List software programs your are proficient using.*

Describe your experience in customer service*

What makes you an ideal candidate? Please describe*

Are you fluent in Spanish?*

Select

Do you fluently speak any other languages?*

Would you like to have medical insurance coverage?*

Select or enter value

Would you like to have dental insurance coverage?*

Select or enter value

Are you currently employed?*

Select

Previous Hourly or Monthly Pay Rate?*

Ideal Hourly or Monthly Pay Rate?*

Prefers full-time or part-time*

Select

Ideal working hours?*

Ideal schedule (Days, start/finish times)*

Are you uploading your resume?*

Select or enter value

Are you uploading a current photo?*

Select or enter value

Are you uploading letters of reference?*

Select or enter value

File Attachments*

Drag and drop files here or

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