How much notice do you need? Are you interested in last minute jobs?
What is the earliest we can call? (We open at 6 am & make calls at 6 for last min jobs) ____
What is the latest you can be called? (We generally will not call after 10 pm) _____
Are you bilingual? If so what languages? ____________________________________________
How many years of experience do you have in the dental field for this area of expertise? ______ How many years of dental experience in a different area? ________ Please list the types of practices you have worked in? __________________________________________________
Dentists, Registered Dental Hygienists and Dental Assistants you will need to provide us a copy of your license/certificate. You will need to keep a copy with you at all times when working as a temporary for Daily Dental Solutions, inc.
Do you have any expanded functions?
Dentist: _ ______ NPI _______ OK Board of Dentistry Lic ______ Controlled Substance
______ Dispensing Dentist ________ OK Bureau of Narcotics _____________ SoonerCare
Please provide concise information regarding your skill & experience level. Include the type of temporary work you are looking for (ex. Dentist, Dental Hygienist, Assistant, Front Office Support, etc.) ________________________________________________________________
_____________________________________________________________________________ Do you smoke? ________ Are you comfortable working with children?_________________ We do background checks on all applicants. Will you pass a background check? ____ Please list any misdemeanor or felony charges that may show up on your record. _____________________________________________________________________________
I have completed this truthfully and to the best of my knowledge.