DenTemps Application
DDS
Last name: *
Your answer
First name: *
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Middle name:
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Position: *
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Home address: *
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Mailing address (if different):
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Phone number: *
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Alternate phone number:
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Email address: *
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Alternate email: *
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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! *
Your answer
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? *
Your answer
If in transition to a new position, when is your last day available for temp work?
Your answer
If looking for perm, how far are you willing to commute for a permanent position?
Your answer
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
Your answer
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
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Education *
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Hobbies / Extra Curricular Activities / Interests
Feel free to tell us about yourself!
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Honors and Awards
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Are you looking to purchase your own practice? *
What type of practice? What geographic location?
Your answer
Procedures Checklist
Do you want to check hygiene only? *
Your answer
Will you check hygiene only if there are no other assignments for the day? *
Your answer
Will you do prophies? *
Your answer
Will you do composites? *
Your answer
Will you do amalgams? *
Your answer
Will you do simple extractions? *
Your answer
Will you do surgical extractions? *
Your answer
Will you do impacted extractions? *
Your answer
Will you do alveoplasty? *
Your answer
Will you do crown and bridge? *
Your answer
Are you okay with prepping but not seating? *
(Crown and bridge)
Your answer
Are you okay with delivering something that you didn't prep? *
(Crown and bridge)
Your answer
Will you work in a health department? *
Your answer
Will you work in a health department that sees all children? *
Your answer
Will you work in a health department that sees children and adults? *
Your answer
Will you work in a health department that sees adults only? *
Your answer
Will you see children in a private practice? *
Your answer
Will you see children in an all pedo office? *
Your answer
Will you see children in an office that sees adults and children? *
Your answer
Will you see children in a private practice that sees adults and children? *
Your answer
Will you do SS crowns? *
Your answer
Will you do pulpotomies? *
Your answer
Will you do molar endo? *
Your answer
Will you do premolar endo? *
Your answer
Will you do anterior endo? *
Your answer
Will you work on partials? *
Making adjustments, taking impressions, delivering
Your answer
Will you work on dentures? *
Making adjustments, taking impressions, delivering
Your answer
Will you work on implants? *
Your answer
Will you work on nitrous patients? *
Your answer
Do you have experience with Cerac machine? *
Your answer
Are there any other skills / experience you would like for us to know?
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