Permanent Placement Application for Candidates Seeking Employment

Permanent Placement Application for Candidates Seeking Employment
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
What Position are you looking for?*
How much experience do you have in this position?
Dentists Only:

*We will need a copy of ALL licensures
Do you currently have any of the licenses / insurances below? (select all that apply)

Oklahoma LicenseDEA LicenseNarcotic LicenseMalpractice Insurance
Registered Dental Hygienists Only:

*We will need a copy of ALL licensures
Do you have a current Oklahoma License?
How long have you been licensed in the state of Oklahoma?
*only if Oklahoma license is currently active
Are you licensed as a Hygienist in any other states?
*If yes, please list what other states you are licensed
Is this a Temporary or Permanent License?
Do you currently have any of the licenses / insurances below? (select all that apply)

Local AnesthesiaNitrous Oxide AdministrationTherapeutic Use of LaserNeuromodulator AdministrationElder Care & Public HealthVenipuncturePhlebotomy
CPR Card Expiration Date
Dental Assistants Only:

*Please indicate any certifications listed on your Permit. We need a color copy of your current Permit through the Board of Dentistry
What certifications listed below do you have? (select all that apply)

CDARadiation SafetyCoronal PolishingSealantsNitrous OxideElder CareVaccines
CPR Expiration Date
Permit Number
Front Office Support Only
What dental software(s) are you familiar with? (select all that apply)

DentrixSoftDentEZDentalEagleSoftDental.comWinDentOpen DentalCurveFuseOther
If selected "other", please identify here
Please select any of the procedures below that you are proficient in

SchedulingInsurance File/ProcessAccounts Payable/ReceivableBillingFinancial ArrangementsRecallCase PresentationPostingMedicaid/Soonercare
ALL Applicants
What areas are you interested in working in? (select all that apply)*

AdaAltusArdmoreBartlesvilleBethanyBlanchardChickashaClintonDuncanEdmondEl RenoEnidGuthrieJenksLawtonMcAlesterMidwest/Del CityMooreMuskogeeMustangNobleNormanNorth OKCPauls ValleyPonca CityPurcellShawneeSouth OKCStillwaterTahlequahTulsaWeatherfordWoodwardYukonOther
If selected "other", please identify here
Many offices now offer early or late hours for patients. Are you interested in positions that start early in the morning?
Are you interested in offices that offer late appointments?
Please list any benefits & salary requirements you are looking for in a position:
What days are you looking for employment?
Are you flexible on what days you can work? Please explain.*
Are you looking for part-time or full-time work?
Please upload your current resume here*

Cancelof
When accepting a permanent position through Daily Dental Solutions, inc. it is your express responsibility to inform us immediately if you are released or resign from the said position.

Please send us a current resume. If possible please include it on CD/Flashdrive or via email in a document form. We reserve the right to verify previous employment & references, as well as, make any needed changes to your resume.
Name*

First NameLast Name
Signature*

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Date*

MonthDayYear
Date
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Permanent Placement Application for Candidates Seeking Employment

Dentists Only:

Registered Dental Hygienists Only:

Dental Assistants Only:

Front Office Support Only

ALL Applicants