Registration: Maricopa County First Teeth First Shiftboard

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APPLICANT INFORMATION
 

ADDITIONAL INFORMATION
Hygenist License ID Number
Is is alright to contact you at work?
 Yes
Dental position applying for?
Prefered Employment Status
Hourly Wage Desired ($)
General Preferences
Please select your Maximum Travel Distance (miles)
Permanent Position Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Temporary Position Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Professional Skills and Experience
Multi-lingual Languages
Spanish
Other
Dental Experience
Dental Assisting School Graduate
Dental Hygiene School Graduate
1-5 years
6-12 years
13-20 years
over 20 years
Dentistry Skills
Post-Operative Instructions
Oral Hygiene Instructions
Preliminary Oral Exam
Four-Handed Chairside
Soft Tissue Management
Charting
Perio Charting
Administering Topical Fluorides
Alginate Impressions
Periodontal Treatment
Polishing Coronal Crowns
Oral Health Instructions
Applying Pit/Fissure Sealants
Filling Out Insurance Forms/Filing
Applying Topical Anesthetic
Suture Removal
Placing/Removing Temp Crowns/Restorations
Assisting in the Administration of NO
Daily Reconciliation
Daily Deposit
Scheduling Appointments
Apply Cavity Liners/Bases
Placing/Removing Periodontal Dressing
Disinfection
Placing/Removing Rubber Dam
Operate Autoclave
Operate Dryclave
Ultrasonic
Dental Software Experience
Additional Skills
Take X-Rays
Panoramic
Bitewings
Full Mouth
Digital
Ceph
Temporary Crowns
Polycarbonate
Acrylic
Tin
Please select any specialty field experience you have
Oral Surgery
Ortho
Perio
Pedo
Training
High School Name
High School Graduation Year

Technical School Name
Technical School Graduation/Certificate Award Year

College/University Name
College/University Graduation/Certificate Award Year
Professional References
First Reference Name
First Reference Phone
First Reference Position
Second Reference Name
Second Reference Phone
Second Reference Position
Employment Experience
Most Recent Employer
Experience (1) Company Name
Experience (1) Position/Title
Experience (1) Supervisor
Experience (1) Address
Experience (1) Start Date
Experience (1) End Date

Prior Employer
Experience (2) Company Name
Experience (2) Position/Title
Experience (2) Supervisor
Experience (2) Address
Experience (2) Start Date
Experience (2) End Date



Thank you for your interest!
 
 
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602-506-6842
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