Current Employment Application

Published on June 2016 | Categories: Topics, Art & Design | Downloads: 32 | Comments: 0 | Views: 138
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hello,this is annamarie just wanted to say that i'm sorry fornot being ble to fill this out sooner and thank you very much for your card loved it !!

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Content

Employment Application & Professional Profile
Contact Information:
Last Name: Mailing Address: City: Date of Birth: Home Phone: State: E-mail Address: Cell Phone: Zip Code: First Name:

Experience & Qualifications:
How many total years of experience in the dental field do you have? Position(s) You Are Willing To Take: (please check all that apply!) Hygienist Chairside Assistant Front Office Cross-training

Arizona Certifications and Licenses: X-ray Certified CPR Certified Ortho. Certificate Laser Certification Oral Surgery
Yes

AZ Anesthesia License Coronal Polishing Certification

IV Sedation Certificate

Have you worked in a specialty office? Do you have experience with:

Endo

Pedo

Perio
Yes

Ortho

Digital x-rays?

CEREC machine?

Are you comfortable presenting treatment plans and different financial options? Are you bilingual? (If yes, which languages?)
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Yes

Please list any dental software program(s) you have used: Please briefly describe any front and/or back office duties you have experience with:

Are you interested in taking temporary positions? Yes

Days Available:
Yes Either

Would you be willing to take a long term temporary position (medical leave, etc.)? Are you currently seeking long term/permanent employment? Yes How many days would you prefer to work and which days? Are you willing to consider other positions that may offer more or less days/hours? Please tell us your desired hourly rate of pay: Low FT or PT?

Yes

High

Please check areas where you would be willing to take a position: Gilbert /Chandler Glendale/Peoria Flagstaff/Winslow Other: Mesa/Tempe Scottsdale/Phoenix Goodyear/Avondale/Surprise Anthem Cottonwood/Sedona Prescott Area Queen Creek Tucson /Marana Lake Havasu

Current Employment:
Are you currently working? Available to start?
Yes

May we contact your current employer? Available for interview?

Yes

What are some things you have liked about your current/last position?

What are some things you have not liked or would change about your current/last position?

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Employment History:
Previous Employer: Dates of Employment: Starting rate of pay: Reason for Leaving: Terminated to Last Rate of Pay: Left by choice Please explain below… Position:

Previous Employer: Dates of Employment: Starting rate of pay: Reason for Leaving: Terminated to

Position:

Last Rate of Pay: Left by choice Please explain below…

Previous Employer: Dates of Employment: Starting rate of pay: Reason for Leaving: Terminated to

Position:

Last Rate of Pay: Left by choice Please explain below…

Please list any additional information you would like us to consider when matching you with positions and job opportunities:

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Interview Questions:
Describe any special skills and personality traits that you possess which you feel make you an exceptional employee and a good “team player”.

What do you feel are some common patient concerns and/or complaints about a dental office?

Keeping your answer to this last question in mind, what are some specific things you feel need to be done in order to bring about “maximum patient satisfaction” (both personally and for the office as a whole)?

On a scale of 1-10 (with 10 being the highest) where do you consider yourself in terms of computer knowledge and experience? (Not just dental software but social marketing, online advertisements, Microsoft programs, etc.) 1 Comments:

What are some qualities you possess that you feel will make you stand out from among other applicants?

Are there any aspects of your positions where you feel you would have room for improvement or might require additional training?

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