Apply for GENERAL DENTIST NEEDED

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:GENERAL DENTIST NEEDED
ID:1021
Department:Human Resources
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Dentist Application Short Version 2024
Please fill our questionary Do No call ,we will contact you if we decide to move forward. Thank You
* Location you are applying to::
Rialto   Rancho Cucamonga   No Preference
* Degree:
DDS   DMD
* Dental school program:
* Graduation year:
* California License Number:
* Do you have over 2 years of clinical experience?
Yes   No
* Do you Have:
California License in good standing , CPR certificate,Professional Liability, DEA certificate ?
Yes   No
* Are you currently employed?:
Yes   No
Have you given notice to your present employer?:
Yes   No
May we contact you present employer?:
Yes   No
* Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?
(Proof of citizenship or immigration status will be required upon employment):
Yes   No
* On what date would you be available to start work?:
* Are you available to work?:
PT   FT   PT/FT   Temporary
What days are you ABLE to work?:
  
  
  
  
  
  

SALARY OFFERED : PER DIEM

* Will you need any special accommodation for any non-job related medical condition or handicap?:
Yes   No

We consider applicants for all positions without regard to race,color,religion,sex,national origin,age,marital status,veteran status,the presence of a non-job-related medical condition or handicap, or any other legally protected status

* LICENSES/CERTIFICATES
Licenses you hold:

SKILL LEVEL / KNOWLEDGE ON

Any other professional skill that may be useful on our practice?

EMPLOYMENT HISTORY Starting with the most recent job

Employer name and Phone#:
Work Performed:
From / To please put exact dates:
Reason for leaving:
Employer name and Phone#:
Work Performed:
From / To please put exact dates:
Reason for leaving:
Employer name and Phone#:
Work Performed:
From / To please put exact dates:
Reason for leaving:
Employer name and Phone#:
Work Performed:
From / To please put exact dates:
Reason for leaving:
* REFERENCES
Please give name,address,and phone number of 3 references not related to you and are not previous employers
* APPLICANT STATEMENT
I certify that answers given herein are true and complete to the best of my knowledge.
I acknowledge and agree that the information that i have provided on this application is accurate and truthful, and this is not a promise to hire. I understand, should I be hired, that if any information proves to be inaccurate,I may be immediately terminated from employment.
I authorize the contact of my former employers for reference information. I agree to release my former employers from any liability in the disclosure of accurate information. I further agree that if I bring any legal claim arising out of employment relationship, that it must be brought within 180 days of the separation from employment.
I have read the job description for which I am applying and understand the responsibilities related to each task
Please sign with your name

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