The Dental Network

It's about People and Positions

Application Form

 

Position Desired:

 

Name   S.S.#

Address  City  State  Zip

TX. DL#  DOB  E-mail

Phone#: Home   WK Cell

Institution Attended     Yr. of Graduation

DDS/RDH License#     Years of Chairside Experience?

Available work days?        Available work months?   

Who referred you to T.D.N?         

Check Office Preference:    GP      Pedo      Perio      Endo      OS      Ortho

Software Knowledge: Dentrix  Eaglesoft  Softdent  Doc-Aid  Other

Check your Placement Preference:    Temporary            Permanent

Compensation Rate?     Preferred areas of Town?

Have you had your Hepatitis Vaccine?    Yes?         No?

Are you Certified in:  Sealants? Radiographs? Are you Familiar with Digital X-RAYS?

List of expanded duties, Include any continuing education

Last (3) Employers beginning with most recent: Include phone numbers

Have ever been charged or convicted of a felony? Yes  No  If yes, explain

Send mail to tdninfo@thedentnet.com with questions or comments about this web site.
Copyright © 2006
Last modified: April 1, 2010

 

Ready to take the next step toward enjoying the benefits of working with The Dental Network?

Please follow these instructions for submitting T.D.N application:

1. Complete the following form with your information. Simply key the information in each field as indicated.

2. Print a hard copy and bring it with you to your interview.

3. Click submit at the bottom of the form to send your information to T.D.N.

 

Note: For  your convenience, follow this process in order. If you click submit before you print a hard copy, the form will reset and you will have to rekey the information.