We are an equal opportunity employer and do not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability, or any other reason prohibited under Federal, State, or local laws.
QUESTIONS ABOUT APPLICANT EMPLOYMENT HISTORY List all positions held, including part-time summer and/or volunteer work and periods of employment for the last ten years; do not omit any employers. Explain any gaps in employment in comment section. If you are submitting a resume, you are still required to provide the requested information in the space provided. If self-employed, provide company name and at least two business references. Attach additional sheets or continue on the back of the page, if needed.
Employer Dates Employed May We Contact - +
SOCIAL TRAINING AND SKILLS Dental Licenses & Certificates Office Skill Typing Skill Level Fair Good Excellent
Bookkeeping Skill Level Fair Good Excellent
Computers Skill Level Fair Good Excellent
Account/ Collections Skill Level Fair Good Excellent
Tax Presentation Skill Level Fair Good Excellent
Fee Presentation Skill Level Fair Good Excellent
Dental Terminology Skill Level Fair Good Excellent
Insurance Processing Skill Level Fair Good Excellent
Scheduling Skill Level Fair Good Excellent
Customer Service Skill Level Fair Good Excellent
Charting Skill Level Fair Good Excellent
Management Skill Level Fair Good Excellent
Clinical Skill Tray Setup Skill Level Fair Good Excellent
Four-Handed Dentistry Skill Level Fair Good Excellent
Six-Handed Dentistry Skill Level Fair Good Excellent
Take, Develop, Mount X-Ray Skill Level Fair Good Excellent
Pour & Trim Models Skill Level Fair Good Excellent
Coronal Polish Skill Level Fair Good Excellent
Fabricate/Cement Temp Crowns Skill Level Fair Good Excellent
OSHA & Safest Regulations Skill Level Fair Good Excellent
Plaque Control Instructions Skill Level Fair Good Excellent
Periodontal Skills Skill Level Fair Good Excellent
Orthodontic Skills Skill Level Fair Good Excellent
Oral Surgery Assisting Skill Level Fair Good Excellent
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I further understand that any employment that is offered to me will be at-will and that this application does not create or imply a contract for employment.
