New Applicant Permanent Placement Application

An Equal Opportunity Employer

It is the policy of Dental Professionals to consider all applicants without regard to race, religion, color, sex, age, marital status, national origin, disability, veteran status or any other basis prohibited by applicable federal, state, or local anti-discrimination laws. Applicants with disabilities needing assistance completing any forms or to otherwise participate in the application process may call 206-767-4851.

*Enter N/A if a required field does not apply.

Applicant Information

Permanent Employment Position

(dentist license, dental hygiene license, or dental assistant registration)

YesNo

YesNo

YesNo

YesNo

YesNo

If yes, state the nature of the offense(s), when and where convicted, and disposition of case.

Resume

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Employment History

(most recent first - last 7 years or last 3 positions required)

Education

High School

YesNo

Vocational School

College

YesNo

APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION

PLEASE READ CAREFULLY

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment or representation. I further understand that, should an offer of employment or representation be extended by Dental Professionals that such employment or representation with Dental Professionals is at will, for no specified duration and may be terminated by either Dental Professionals or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Dental Professionals or its representatives used during the employment process is deemed a contract of employment or representation real or implied. In consideration for employment or representation with Dental Professionals, if employed, I agree to conform to the rules, regulations, policies and procedures of Dental Professionals at all times and understand that such obedience is a condition of employment or representation.

I understand that if offered a position with Dental Professionals, I will be required to submit to a pre-employment background check as a condition of employment and the results of this check may be provided to any clients to whom I am assigned. I understand that a background investigation may include verification of information I have provided to Dental Professionals, my criminal conviction record for the past ten years, my past employment and volunteer history, my personal and professional references, and a credit check as Dental Professionals may determine is required by business necessity. Dental Professionals must inform me if it makes an adverse employment decision based on information it obtains conducting this background investigation. I am entitled to receive, upon my written request, a disclosure of the nature and scope of any background investigation results. *

If I am offered a position with Dental Professionals, I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Dental Professionals and/or any of its prospective employers and I release all parties involved from any and all liability for any and all damage that may result from providing such information. *

BY CLICKING THE BOX BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.