top of page

Candidate
Application

​

Address

Date of Birth

Phone Number

Email

Employment Desired

License #

Are you experienced in any of the following fields?

Please check all that apply

Available Days

Please check all that apply Required

References - List 3 Professional

Previous Employment

Which dental softwares are you familiar with?

Education

Are you a U.S. Citizen

Languages Spoken?
 

Do you have a valid x-ray license?

Please check off the following duties you are qualified to perform.

Check all that apply

Are you experienced in Digital X-Rays

Please check off the following duties you are qualified to perform.

Check all that apply

Are you experienced with dental insurances and sending out claims for specific procedures?

Can you schedule appointments?

Can you schedule appointments?

Check all that apply

Askdentalstaffing@gmail.com

Phone Number Privacy Policy: We respect your privacy and are committed to protecting your personal information. Use of Information: We use your phone number to send SMS messages regarding your inquiries and customer care. Data Sharing: Phone information or opt-in data collected will not be shared, sold, or disclosed to any third parties or affiliates for marketing purposes. Opt-Out: Reply "STOP" to unsubscribe or "HELP" for assistance. Message Disclosures: Message frequency varies. Message and data rates may apply. Data Security: Your data is protected and retained only as necessary.

bottom of page