Interested in joining the Westwind Dental Team? Click to fill out the Application below."
Position Desired* : Full-time Part-Time
Salary Expected* :
Are you eligible for employment in the U.S.A?* : Yes No
Have you ever convicted a criminal offense?* : Yes No
If yes, State offense, date, and location :
Do you know any reason why you cannot be bonded? :
Time you are willing to work:
Full-time Days: M T W TH F S
Part-time Days: M T W TH F S
Have you had experience in the following? (Circle NO if NOT within the last 3 years)
Typing : Yes No
Computerized Book Keeping : Yes No
Account Collecting : Yes No
Insurance Processing : Yes No
Charting : Yes No
C.P.R Training : Yes No
Plaque Control Instructions : Yes No
Four-Handed Assisting : Yes No
Dental Terminology : Yes No
Take/Develop/Mount X-rays : Yes No
Pour or Trim Models : Yes No
Fabricate Temporary Crowns : Yes No
Tray Set-Up : Yes No
Coronal Polishing : Yes No
Do you have any physical conditions which could limit your ability to perform the job for which you have applied?
Do you speak a language other than English which could be relevant or helpful in the position for which you have applied?
X-Ray Certification: Yes
Continued Education Courses Taken in the Last 2 years:
List recent position’s first.
I have added my resume to attachment.
Name Of Supervisor:
Reason for Leaving:
If now employed, why do you desire to change?:
Have you notified your present employment that you are seeking other work
Unemployed at the moment
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.