Request Form
Our agency provides reliable means to connect you with a rich pool of qualified candidates. Therefore, when a shortage of staff occurs, you are invited to notify Connections Dentaires that a temporary or permanent employee is needed
Email address *
Name of the Clinic: *
Your answer
Name of the doctor: *
Your answer
Address: *
Your answer
Contact Person: *
Your answer
Name of Dental Software:
Your answer
Phone number: *
Your answer
Requested Personal: *
Required
Duration: *
Required
Work Experience:
Language Capabilities:
Hours of operation:
****fill out only two boxes for duration*****
7:00
8:00
9:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
Monday
Tuesday
Wedensday
Thursday
Friday
Saturday
Sunday
Starting Date:
MM
/
DD
/
YYYY
Salary:
Your answer
Personal Specifications:
Your answer
Dentist's Initialize and Current Date: *
- No registration or search fees. - Fees will be applicable should you select a candidate referred by Dental Connections within a 12 month period after the initial referral fees payable within 14 days of invoice. - 5% interest per month applicable on late payments. - Dental Connections acts only as a reference and holds no responsibility for the personal or professional acts of the referred candidates. - 30 day decreasing warranty applies to full and part time placements once payments have been received.
Required
A copy of your responses will be emailed to the address you provided.
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