Phone: ____________________________ Alternate Phone: ____________________________
What Position are you looking for? _________________________________________________
How much experience do you have in this position? ____________________________________
Do you currently have: Oklahoma License ______ DEA License ______
Narcotic License _______ Malpractice Insurance ________ SoonerCare ________
Registered Dental Hygientist Only:
Oklahoma License ______ How long have you been licensed in the state of Oklahoma? _______
Is this a Temporary or Permanent License? _______ Are you licensed for Local Anesthesia and/or
Nitrous Oxide Administration? ______
Dental Assistants Only: Please indicate any certifications you have for expanded functions...
CDA Radiation Safety Coronal Polishing Sealants Nitrous Oxide OK Permit
Front Office Support Only: What dental softwares are you familiar with:
Dentrix SoftDent EZDental EagleSoft Dental.com WinDent
Please indicate the procedures you proficient in: ___ Scheduling ___ Insurance File/Process
___ Accounts Payable/Receivable ___ Billing ___ Financial Arrangements ___ Recall
___ Pegboard ___ Case Presentation ___ Posting
To All Applicants: Are there any specific areas you are interested in working in?
North OKC Edmond Guthrie Bethany Yukon El Reno South OKC
Moore Norman Noble Chickasha Lawton Purcell Shawnee
Midwest/Del City Mustang Blanchard Pauls Valley Tulsa Jenks
Ponca City Enid Stillwater Woodward Clinton Ada Weatherford
Duncan Altus Muskogee Tahlequah Bartlesville Ardmore McAlester
Many offices now offer early or late hours for patients. Are you interested in positions that start early in the morning?_________ Are you interested in offices that offer late appointments? ______
Are there benefits you are looking for in a position? Please Specify _________________________
What days are you looking for employment? _________________________________________
Are you flexible on the days? _______ Are you looking for Part-time or Full-time? _____________
When accepting a permanent position through Daily Dental Solutions, inc. it is your express responsibility to inform us immediately if you are released or resign from the said position.
Please send us a current resume via email or send it on flash drive or CD. We reserve the right to verify previous employment & references, as well as, make any needed changes to your resume.
______________________________ _____________________________ ____________
Print Name Signature Date