Isaac Knapp District Dental Society Sub List
Please fill out the information below to be placed on our sub list. Your information will remain on the list for 1 year, unless you notify the IKDDS office to update. You must re-submit your information annually to ensure that the most recent information is distributed to dental offices.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Position you are qualified to sub for:
Hygienist
Dental Assistant
Office Assistant
Lab Tech
Other
Are you x-ray certified?
Yes
No
N/A
Are you expanded duties?
Yes
No
N/A
What days are you available to sub?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Are you interested with long-term sub opportunities?
Yes
No
Maybe
Example: to fill for someone on maternity leave
Additional comments
Contact information will be kept for sub list distribution to IKDDS Members for 1 year. I will need to re-submit information annually.
*
Yes, I understand IKDDS will keep my information for 1 year.
Submit
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