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Dental Placement Services - Workers

This is a Dental Placement Service only. There is NO charge for Associate Dentist's looking for work.

Please fill out the form below if you are a Dentist looking for work.

Worker Sign Up

Full Name:

Sex:

Email:

Cell Phone:

Office Phone:

Home Phone:

Address:

Adress Type:

Home

Office

In what locations/areas are you interested in working? (Separate with commas)

How many miles are you willing to travel from home?

Would you be willing to relocate?

Yes

No

What areas are you willing to relocate to:

Which is the best way for Employers to contact you for an interview?

Home

Office

Cell

Email

What school did you graduate from?

What year did you graduate?

DMD or DDS?

DMD

DDS

Enter your License Number:

Are you Left or Right handed?

Left

Right

What type of dentist are you?

Generalist

Specialist - Oral Surgeon

Specialist - Ortho

Specialist - Pedo

Specialist - Prostho

Specialist - Perio

Date available to begin work:

Do you have a medicaid license?

Yes

No

Enter your Medicaid License # or "N/A":

Are you interested in Full-/Part-time?

Full-time

Part-time

Either

Will you accept Temporary Placement?

Yes

No

Are you interested in an associateship, buy-in, or buy-out?

Associateship

Buy-in or Buy-out

Either

WHO DO YOU CURRENTLY WORK FOR? (Please supply name of Doctor)

Describe what you are looking for and your experience:

Disclosure

** The above information will not be distributed to third parties and personal information will NEVER be displayed on website. Any contact info will be given privately. Private Health Information should not be sent in this form. We will contact you directly. **

AGREEMENT

Your Full Name Below Constitutes your Signature.

DISCLAIMER: Any referral cannot be used by any individual, practice or organization in regard to placement whatsoever, more particularly sue owner personally or Smile Placement.com for any placement. Every individual, entity or organization should seek competent legal advice.

I agree to all of the above

By checking, I agree to share my form responses.

Today's Date:

Signature

Thank you for contacting us.
We will get back to you as soon as possible.

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Email your resume to: sandy@smileplacement.com

Contact Us

Phone: 561-262-5429

Email: Sandy@SmilePlacement.com

Office Hours:

By Phone:
Monday-Thursday: 6:00pm-7:30pm

Saturday: 10:00am - 1:00pm Eastern

Email: 24/7

Location:

6256 Foster St, Jupiter FL 33458, United States

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