APPLICATION FOR EMPLOYMENT

APPLICANT FOR EMPLOYMENT

PREMIER SMILES ORTHODONTICS, GROWING SMILES CHILDREN'S DENTISTRY, INNOVATIVE SMILES & VIP DENTAL ASSISTING SCHOOL ARE AN EQUAL OPPORTUNITY EMPLOYERS
APPLICANT INFORMATION
APPLICATION DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
FIRST NAME
MIDDLE NAME
LAST NAME
HOW DID YOU HEAR ABOUT THIS POSITION?
HOW DID YOU HEAR ABOUT US?
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHONE NUMBER
PLEASE ENTER A VALID PHONE NUMBERFormat: (000) 000-0000.
EMAIL
example@example.com
ARE YOU AUTHORIZED TO WORK IN THE U.S.
ARE YOU CURRENTLY EMPLOYED?
IF YES, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?
HAVE YOU EVER APPLIED TO OR WORKED FOR OUR COMPANY BEFORE?
IF "YES", WHEN?
POSITION DESIRED
COMPANY APPLYING TO
POSITION APPLYING FOR
POSITION APPLYING FOR
PSO
POSITION APPLYING FOR
GS
POSITION APPLYING FOR
VIP
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
DESIRED SALARY
EDUCATION / TRAINING / SKILLS
HIGH SCHOOL
LOCATION
CITY & STATE
NUMBER OF YEARS
GRADUATE?
SUBJECTS STUDIED
COLLEGE
LOCATION
CITY & STATE
NUMBER OF YEARS
GRADUATE?
SUBJECTS STUDIED
OTHER
LOCATION
CITY & STATE
NUMBER OF YEARS
GRADUATE
SUBJECTS STUDIED
SPECIAL/RELEVANT SKILL & TRAINING, OR MEMBERSHIPS
MILITARY SERVICE
BRANCH
FROM - TO
RANK AT DISCHARGE
TYPE OF DISCHARGE
INTERNAL REFERENCES

PLEASE LIST ANY RELATIVES OR FRIENDS THAT ARE CURRENTLY EMPLOYED BY PREMIER SMILES ORTHODONTICS, GROWING SMILES CHILDREN'S DENTISTRY, INNOVATIVE SMILES CLE, OR VIP DENTAL ASSISTING SCHOOL
FULL NAME

FULL NAMELast Name
TITLE
RELATIONSHIP
FULL NAME

FULL NAMELast Name
TITLE
RELATIONSHIP
FULL NAME

FULL NAMELast Name
TITLE
RELATIONSHIP
CRIMINAL HISTORY

Some cities and states prohibit prospective employers from asking whether an applicant has been convicted of a crime at the beginning of the application process. Do not provide conviction information if located in California, Connecticut, District of Columbia, Hawaii, Illinois, Baltimore MD, Montgomery County MD, Prince George’s County MD, Massachusetts, Minnesota, New Jersey, Buffalo NY, New York City NY, Oregon, Philadelphia PA, Austin TX, Vermont, Seattle WA, Spokane WA, or other jurisdictions where prohibited.
IN THE LAST 7 YEARS, HAVE YOU BEEN CONVICTED OF A CRIME, EXCLUDING MISDEMEANORS, WHICH HAS NOT BEEN ANNULLED, EXPUNGED, OR SEALED BY A COURT?
IF YES, DESCRIBE IN FULL
EMPLOYMENT HISTORY
COMPANY
PHONE NUMBER
PLEASE ENTER A VALID PHONE NUMBERFormat: (000) 000-0000.
START DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
END DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PAY
Some cities and states prohibit prospective employers from asking for applicants’ salary histories. Do not provide pay information if located in California, Delaware, Massachusetts (eff. 7/1/18), New York City NY, Oregon (eff. 1/1/2019), Philadelphia PA, Puerto Rico, or other jurisdictions where prohibited.
ADDRESS
CITY & STATE
SUPERVISOR
MAY WE CONTACT YOUR EMPLOYER
JOB TITLE
RESPONSIBILITIES
REASON FOR LEAVING
COMPANY
PHONE
PLEASE ENTER A VALID PHONE NUMBERFormat: (000) 000-0000.
START DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
END DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PAY
Some citiesand states prohibit prospective employers from asking for applicants’ salary histories. Do not provide pay information if located in California, Delaware, Massachusetts (eff. 7/1/18),New York City NY, Oregon (eff. 1/1/2019), Philadelphia PA, Puerto Rico, or other jurisdictions where prohibited.
ADDRESS
CITY & STATE
SUPERVISOR
MAY WE CONTACT YOUR PREVIOUS EMPLOYER?
JOB TITLE
RESPONSIBILITIES
REASON FOR LEAVING
COMPANY
PHONE NUMBER
PLEASE ENTER A VALID PHONE NUMBER Format: (000) 000-0000.
START DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
END DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PAY
Some cities and states prohibit prospective employers from asking for applicants’ salary histories. Do not provide pay information if located in California, Delaware, Massachusetts (eff. 7/1/18), New York City NY, Oregon (eff. 1/1/2019), Philadelphia PA, Puerto Rico, orother jurisdictions where prohibited.
ADDRESS
CITY & STATE
SUPERVISOR
MAY WE CONTACT YOUR PREVIOUS EMPLOYER?
JOB TITLE
RESPONSIBILITIES
REASON FOR LEAVING
PROFESSIONAL REFERENCES

PLEASE LIST THREE PROFESSIONAL REFERENCES NOT RELATED TO YOU
FULL NAME

FULL NAMELast Name
TITLE
PHONE NUMBER
PLEASE ENTER A VALID PHONE NUMBER Format: (000) 000-0000.
RELATIONSHIP
COMPANY
ADDRESS
CITY & STATE
YEARS ACQUAINTED
FULL NAME

FULL NAMELast Name
TITLE
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
RELATIONSHIP
COMPANY
ADDRESS
CITY & STATE
YEARS ACQUAINTED
FULL NAME

FULL NAMELast Name
TITLE
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
RELATIONSHIP
COMPANY
ADDRESS
CITY & STATE
YEARS ACQUAINTED
You may upload your cover letter or resume here

Cancelof
I understand that completion of this Application does not constitute an offer of employment. I certify that all information provided herein is true, correct, and complete. I understand that, if employed, any false information, misstatements, omissions, or misrepresentations on this Application may result in my dismissal. I authorize the investigation of all statements contained herein and give the references and employers listed above permission to provide all pertinent information concerning my previous employment. If employed, I agree to follow the COMPANY's rules and regulations and I understand and agree that the terms of my employment maychange, with or without notice, at any time. I further understand thatacceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future or for a specific length of time, and I agree that employment may be terminated, with or without cause, with or without notice, by either myself or the COMPANY at any time.
TODAY'S DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearAPPLICATION DATE
SIGNATURE
Should be Empty:

APPLICANT FOR EMPLOYMENT

APPLICANT INFORMATION

POSITION DESIRED

EDUCATION / TRAINING / SKILLS

MILITARY SERVICE

INTERNAL REFERENCES

CRIMINAL HISTORY

EMPLOYMENT HISTORY

PROFESSIONAL REFERENCES