DenTemps Application
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DDS
Last name: *
Middle name:
First name: *
Position: *
Home address (including city, state & zip): *
Mailing address (if different - including city, state & zip):
Phone number: *
Alternate phone number:
Email address: *
Alternate email: *
How did you hear about DenTemps? (select all that apply) *
Required
Did anyone refer you to working with us? If so, please let us know so we can thank them! *
Are you interested in: *
Required
What days are you available to temp? *
Required
What cities will you work in? *
Required
When are you available to begin temping? *
If in transition to a new position, when is your last day available for temp work?
If looking for perm, how far are you willing to commute for a permanent position?
Would you consider commuting farther (for temporary work) if mileage and/or a hotel were compensated? *
Required
Are you an approved Medicaid provider? *
Objective / Career Goal
Work History *
List the dates of employment, position/ job title, and name of the company / office / DDS. You may also list duties and responsibilities as well
Education *
Hobbies / Extra Curricular Activities / Interests
Feel free to tell us about yourself!
Honors and Awards
Are you looking to purchase your own practice? *
What type of practice? What geographic location?
Procedures Checklist
Do you want to check hygiene only? *
Will you check hygiene only if there are no other assignments for the day? *
Will you do prophies? *
Will you do composites? *
Will you do amalgams? *
Will you do simple extractions? *
Will you do surgical extractions? *
Will you do impacted extractions? *
Will you do alveoplasty? *
Will you do crown and bridge? *
Are you okay with prepping but not seating? *
(Crown and bridge)
Are you okay with delivering something that you didn't prep? *
(Crown and bridge)
Will you work in a health department? *
Will you work in a health department that sees all children? *
Will you work in a health department that sees children and adults? *
Will you work in a health department that sees adults only? *
Will you see children in a private practice? *
Will you see children in an all pedo office? *
Will you see children in an office that sees adults and children? *
Will you see children in a private practice that sees adults and children? *
Will you do SS crowns? *
Will you do pulpotomies? *
Will you do molar endo? *
Will you do premolar endo? *
Will you do anterior endo? *
Will you work on partials? *
Making adjustments, taking impressions, delivering
Will you work on dentures? *
Making adjustments, taking impressions, delivering
Will you work on implants? *
Will you work on nitrous patients? *
Do you have experience with Cerac machine? *
Are there any other skills / experience you would like for us to know?
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