Personal Information

Name:*

First NameLast Name

Email:*

example@example.com

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:*

Area CodePhone Number

What position are you applying for?*

Dental Office EmployeeAssistantLead Assistant

Which Family Smiles location are you applying for?*

Are you interested in full-time or part-time?

Full-timePart-time

What is your yearly income desired?

When are you available to begin working?

Date

What is your availability for work?

Are you bilingual? If yes, what languages do you speak/write/read?

How did you hear about this position?

Are you eligible to work in the US?*

YesNo

Have you ever been convicted of a felony?*

YesNo

Have you ever been in the military service?*

YesNo

Use this space for felony convictions or military service details. Leave blank if not applicable.

Company name:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

Area CodePhone Number

Supervisor name:

Job title:

Starting salary:

Ending salary:

Responsibilities:

When did you begin?

Date

When did you stop working?

Date

Reason for leaving:

May we contact this employer for a reference?

YesNo

Do you have more work history? Please upload a resume.

Browse Files

What is your highest level of education completed?*

Name of institution:*

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Begin date:*

Date

End date:*

Date

What did you earn?*

DISCLOSURE

As an applicant for employment or an employee of this organization, you have rights under the Fair Credit Reporting Act (FCRA). By this document, this organization discloses to you that a consumer report may be obtained for employment purposes as part of the pre-employment background investigation and at any time during your employment, if you are hired. If this organization obtains a consumer report about you, and if this organization considers any information in the consumer report when making an employment related decision that directly and adversely affects you, this organization will provide you with a copy of the consumer report and a summary of your rights under the FCRA before the decision is finalized. You also may contact the Federal Trade Commission about your rights under the FCRA.

AUTHORIZATION

By submitting this application, I acknowledge that I have received the foregoing disclosure that this organization may obtain a consumer report as part of its pre-employment background investigation and/or during the course of my employment, if I am hired. By submitting this application, I voluntarily authorize this organization to obtain consumer reports about me and to consider the consumer report in its pre-employment background investigation and/or when making decisions during the course of my employment, if I am hired. I understand that I have rights under the Fair Credit Reporting Act, including the rights discussed.

EMPLOYMENT DISCLOSURE

All qualified applicants will receive consideration for employment without regard to sex, race, color, national origin or ancestry, age or disability. No information on this application will be used for the purpose of discrimination.

Submitting this application certifies that my answers to the forgoing questions are true and correct and that I understand that intentionally false information will result in refusal of employment or termination of employment if discovered after the date of hire.

I understand that, if hired, my status is that of an employee at will, meaning that I have no contractual right, express or implied, to remain in this organization's employ. In consideration of my employment, I specifically agree that my employment or the terms and conditions thereof including compensation can be changed or terminated with or without cause and with or without notice at any time at the option of this organization. I further understand that, if hired, my employment is for no definite period and either this organization or I may terminate our relationship at will at any time and that this employment application does not constitute an employment contract.

I voluntarily grant this organization the right to investigate and verify the information and statements I have provided in this application and agree to hold all persons harmless with respect to any information they may give, receive or verify.

I agree that, if hired, I will observe all policies and strict confidentiality concerning all affairs of this organization and its members.

By submitting this application, I affirm that I have read and agree to all of the disclosures and conditions included in the on-line application.

I hereby acknowledge and agree that any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further agreed that this "at will" employment relationship may not be changed by any written document or by conduct, unless such change is specifically agreed and acknowledged in writing by an authorized executive of this organization.

Check this box after you have read the disclosure statement.*

Check here and submit your application.

Personal Information

Employment History

Education

Disclosure Statement