CL Online Employment Application for Dental Office

Please fill out the form below and upload your resume and any letter of reference or recommendation. If you have a recent photo that you would like to upload as well, please do so. 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*

Are you a DA, RDA, RDH ?*

Select

Prefer to be front office, back office or both*

Select or enter value

How comfortable are you using computers?*

Select or enter value

List software programs your are proficient using.*

Describe prior experience in a dental office.*

What makes you an ideal candidate? Please describe*

Are you fluent in Spanish?*

Select

Do you fluently speak any other languages?*

Are you currently employed?*

Select

City of Residence*

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

Would you like to have medical insurance coverage?

Select or enter value

Would you like to have dental insurance coverage?

Select or enter value

Ideal Hourly or Monthly Pay Rate?*

Previous Hourly or Monthly Pay Rate?

Ideal schedule (Days, start/finish times)*

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