Blue Wolf Dental Team Apply Online *Full Name*Address*Phone Number*Email*Date of Birth*Are you 16 years of age or older? Yes No *Position DesiredDental Assistant Receptionist/Front Desk Coordinator Hygienist Type of Employment Desired Full Time Part Time Temporary *Date AvailableSalary/Wage DesiredHow did you hear about this position?*Are you legally eligible for employment in the United States? Yes No Office Skills N/A Keyboard skills Bookkeeping Word Processing Excel Single/Multi-line Phone Skills Account Collections Treatment Presentation Fee Presentation Dental Terminology Insurance Processing Appointment Scheduling Charting Other Special Office Training and Skills:Clinical Skills N/A CPR Certification Other Special Clinical Training and Skills:*Have you ever been convicted of, or pled guilty or no contest to, a crime other than a minor traffic violation? Yes No If yes, please explain in detail below Include the date of final disposition of the case and the nature of the offense This information will not necessarily disqualify you from employment, but false or misleading information will*Highest level of education completed? Bachelor Degree Associate Degree Some College Current College Student High School Diploma Grade 11 Grade 10 1) College/University/Trade School:1) City & State:1) Degree or Diploma:1) Major Date of Graduation:1) Date of Graduation:2) College/University/Trade School:2) City & State:2) Degree or Diploma:2) Major Date of Graduation:2) Date of Graduation:3) College/University/Trade School:3) City & State:3) Major Date of Graduation:3) Degree or Diploma:3) Date of Graduation:*Have you previously been employed? Yes (list previous employers information below) No 1) Employer Name:1) Employer Phone:1) May we contact? Yes No 1) Address:1) Dates of Employment:1) Reason for Leaving:1) Responsibilities:2) Employer Name:2) Employer Phone:2) May we contact? Yes No 2) Address:2) Dates of Employment:2) Reason for Leaving:2) Responsibilities:3) Employer Name:3) Employer Phone:3) May we contact? Yes No 3) Address:3) Dates of Employment:3) Reason for Leaving:3) Responsibilities:Upload Your Resume*I certify that my answers are true and complete to the best of my knowledge Yes No Fields with (*) are required