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Client Registration: MDC Staffing LLC, Shiftboard

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APPLICANT INFORMATION
 

ADDITIONAL INFORMATION
Preference: Male or Female
Company Name
Does your office use film x rays?
 Yes  No
Does your office use digital X rays?
 Yes  No
What type of Digital X rays does your office use?
Does your office use Cerec?
 Yes  No
Does your office use iTero?
 Yes  No
Is your office paperless?
 Yes  No
What software does your office use?
What is your payroll Protocol?
Temp will be paid
TEMP WILL BE PAID BY
If other, please explain.
Additional Notes or special requests
Time Alloted for Hygiene Appointments:
Adult Recare
New Patient
Perio
Pedo
Ortho
Traditional
 Yes  No
Invisalign
 Yes  No
Does you office do ortho?
 Yes  No
Other

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