Office Administration Registration

Please fill out the following application for Office Administration positions.


* required field
APPLICANT INFORMATION
 

ADDITIONAL INFORMATION
Birthdate
SSN
Multi-lingual Languages
Spanish
Other
Dental Experience
Office Trained
Dental Assisting School Graduate or Dental Hygiene School Graduate
1-5 years
6-12 years
13-20 years
over 20 years
Please select any specialty field experience you have
Oral Surgery
Ortho
Perio
Pedo
Alright to contact at work?
 Yes
Hourly Wage Desired ($)
Maximum Travel Distance (miles)
Prefered Employment Status
Permanent Position Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Temporary Position Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Education
High School Name
High School Graduation Year
College/University Name
College/University Graduation/Certificate Award Year
Technical School Name
Technical School Graduation/Certificate Award Year
References
First Reference Name
First Reference Phone
First Reference Position
Second Reference Name
Second Reference Phone
Second Reference Position

Skills
Rate your ability in the areas below: (0-none, 1-very little, 2-average, 3-above average) Please only fill out the areas you are willing to work in. Please be honest and accurate of your self-assessment of skills.
Accounts Payable
Collections
Electronic Filing (with attachments)
Taxes
Financial Arrangements
Computer Skills
Correspondence
Recall
Payroll
Appointment Scheduling
Monthly Statements
Marketing
Accounts Receivable
Insurance
Dental Software
Please list any Dental Software Used

Emergency Contact Information
Emergency Contact
Emergency Phone
Emergency Phone (2)
Emergency Contact (2)
Emergency Contact Relationship
Emergency Contact Relationship (2)



Thank you for your interest!
 
 
Jamestown, North Carolina 27282
336-307-3631
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