Job Application Form

Employment Application Form

805 North Frankford Ave, Lubbock TX 79416 (806)799-6780
We’re so glad you’re interested in joining our team at Massey Orthodontics! Before we get to know you better, please upload your résumé below. Then take a few moments to share your heart with us.

Our clinic is more than a place to straighten teeth. We’re here to inspire radiant smiles and encourage healthy, abundant lives. We believe in creating a place where people feel seen, supported, and genuinely loved, and that starts with our team.
Resume Upload

No need to enter your work and education history below! Upload a resume here and continue on!
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Personal Information
Full Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number
Are you a U.S. Citizen?

YesNo
Have you been convicted of a felony within the last 7 years? (conviction will not disqualify an applicant)*

YesNo
Employment Desired:
Position Applying For
Are you looking for a

Full-Time PositionPart-Time PositionOpen to Either
Do you have any schedule limitations or availability notes you’d like us to know?
What drew you to apply at Massey Orthodontics?
Our core HEART values are:

Hospitable – Creating a warm, welcoming space
Enthusiastic – Showing joy and positive energy
Attentive – Being detail-oriented and focused
Relatable – Connecting with patients and teammates alike
Trustworthy – Being reliable and full of integrity
Which of these values comes most naturally to you, and why?
Available Start Date

MonthDayYear
Salary Desired
Current Employment:
Current Employer
Name of Current Employer of NONE if not employed
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
Date
May we contact?

YesNo
Personal and Professional References:
Personal Reference: Name
Email*
Phone*
Why have you chosen this person as a reference?
Professional Reference: Name
Phone*
Email*
Why have you chosen this person as a reference?
Core Values Assessment
These are the Core Values that Massey Orthodontics holds for our patients. They define our HEART for our patients.
- Hospitable
- Enthusiastic
- Attentive
- Relatable
- Trustworthy
In your own words, please tell us:

1. What each of these values mean to you.
2. An example of how you have seen this trait displayed or how you have seen the opposite displayed.
3. Tell us how the presence or absence of this trait made you feel.
Hospitable*
Enthusiastic*
Attentive*
Relatable*
Trustworthy*
How we interact with our patients is represented with SOUL

Serve the Patient
Overcommunicate the Benefit
Understand > Understood
Listen Without Judgment

In your own words, please tell us what each of these directives means to you.
Serve the Patient*
Overcommunicate the Benefit*
Understand > Understood*
Listen without Judgment*
Finishing Up!
Is there anything else you'd like us to know?
By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, omissions, of misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company’s option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
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Employment Application Form

Personal Information

Employment Desired:

Current Employment:

Personal and Professional References:

Core Values Assessment

Finishing Up!