DenTemps Application
Dental Assistant
Last name: *
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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 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)
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
Objective / Career Goal
Tell us what you're hoping to achieve!
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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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Computer and Dental Software Experience *
Select any that you have experience with
Required
What X-rays are you familiar with?
References *
Names and phone numbers of 2-3 dental references. We need someone who has supervised your work. Friends, family and other DAII's will not do.
Your answer
Procedures Checklist
Can you pack cord? *
How comfortable are you doing that?
Your answer
Can you make temps? *
How comfortable are you doing that?
Your answer
Can you do sealants? *
How comfortable are you doing that?
Your answer
Can you take impressions? *
How comfortable are you doing that?
Your answer
Can you pour up models? *
How comfortable are you doing that?
Your answer
Do you have any experience with crown & bridge? *
How comfortable are you doing that?
Your answer
Have you placed the rubber dam? *
How comfortable are you doing that?
Your answer
Have you placed the matrix band? *
How comfortable are you doing that?
Your answer
Can you assist with composites and amalgams? *
How comfortable are you doing each?
Your answer
Have you worked with implants? *
How comfortable are you doing that?
Your answer
Have you done endo? *
How comfortable are you doing that? Was it with a specialist or a general practice?
Your answer
Have you done perio? *
How comfortable are you doing that? Was it with a specialist or a general practice?
Your answer
Have you done pedo? *
How comfortable are you doing that? Was it with a specialist or a general practice?
Your answer
Do you have any oral surgery experience? *
How comfortable are you doing that? Was it with a specialist or a general practice?
Your answer
Do you have any prosthedontic experience? *
How comfortable are you doing that? Was it with a specialist or a general practice?
Your answer
Do you have an ortho experience? *
Your answer
Have you been trained on Cerac machine? *
Your answer
Have you used Brite Smile or Zoom Whitening? *
Your answer
Are there any other skills/experience that would like for us to know?
Your answer
Will you do Hygiene Assisting? *
Your answer
Are you cross trained? *
Will you as front desk?
If you are Front Desk trained, please SUBMIT THIS APPLICATION FIRST and then fill out the Front Desk application, as well!
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