Our Culture & Vision

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Interested in joining the Westwind Dental Team? Click to fill out the Application below."

General Information


 Full-time Part-Time

 Yes No

 Yes No


 M T W TH F S
 M T W TH F S
 Days Evenings

Experience & Skills


Have you had experience in the following? (Circle NO if NOT within the last 3 years)

 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No

 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No

Other:

Do you have any physical conditions which could limit your ability to perform the job for which you have applied?

 Yes No

If yes,Explain:

Do you speak a language other than English which could be relevant or helpful in the position for which you have applied?

 Yes No

If yes,Explain:

Are you:

 Right-Handed Left-Handed

Education


Last High School Attended Location Grade Completed
College Location Date Attended Degree

Date Earned:

X-Ray Certification:  Yes

RDA:  Yes

CDA:  Yes

RDH/LDH:  Yes

Continued Education Courses Taken in the Last 2 years:

Employment History


List recent position’s first.

 I have added my resume to attachment.

Date Employer Salary Description of Duties
Started:
Ended:
Name:

Address:

Name Of Supervisor:

Start $:

Last $:

Title:

Duties:

Reason for Leaving:

Started:
Ended:
Name:

Address:

Name Of Supervisor:

Start $:

Last $:

Title:

Duties:

Reason for Leaving:

Started:
Ended:
Name:

Address:

Name Of Supervisor:

Start $:

Last $:

Title:

Duties:

Reason for Leaving:

Started:
Ended:
Name:

Address:

Name Of Supervisor:

Start $:

Last $:

Title:

Duties:

Reason for Leaving:



If now employed, why do you desire to change?:

Have you notified your present employment that you are seeking other work

 Yes No

 Unemployed at the moment

This office does NOT discriminate in hiring or employment on the basis of race, color, religion, national origin, gender, age, or physical or mental disability.

The information given on this application is accurate. I understand that the furnishing or any misleading or incorrect information will render this application void and will be just cause of immediate termination in the event of employment. I hereby grant permission to Westwind Dental or its duly authorized representative to contact any person, companies, schools, or health care provider names or referred to this application (other than my present employer), and herby authorize these persons, companies, schools and health care providers to provide record, reason for leaving, and all other information they have concerning me to Westwind Dental. I further release all such parties and Westwind Dental from any and all liability claims for damage whatsoever that may result from such contact or information.

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