Employment Application-  Dental Positions

Please complete the below application for all dental positions for further consideration. Once we have received your application, a MVP representative will contact you.

Applicant's Full Name:

Mailing Address:

City, State, Zip:

Physical Address:

City, State, Zip:

Telephone:            

Message / Cell:

Email:

POSITION INFORMATION:

Position Applying For:

Status:

Full-Time Only Part-Time Only Full and Part Time          Temporary Only Temporary-Hire Only Direct Hire Only All

Minimum Wage Accepted:        Desired Wage:

Cities willing to work in (select all that apply):

*To Select Multiple Cities, press crtl and click on cities*

Salem/Keizer Woodburn McMinnville Silverton Stayton/Sublimity Dallas Grand Rhonde Lincoln City Albany Corvallis Eugene/Springfield  

EDUCATION: (list applicable education first)

College / Trade School:

Program / Area of Study:

Date of Graduation or Expected Graduation:

College / Trade School #2:

Program / Area of Study:

Date of Graduation or Expected Graduation:

SKILLS:                                                                               Indicate whether you possess the skill by marking "experience" if you have experience utilizing the skill, or "in-school" if you were taught the skill in school.

*Please do not mark experience for in-school experience, except clinical / externship.

Leave blank if neither apply.

Bilingual: No English/Spanish English/Russian English/ASL English/Other

Typing: WPM; 10-Key / KPM

Multiline Phones: Lines

Dental Appointment Scheduling:  Experience In-School

Dental Records:  Experience In-School

Dental Transcription:  Experience In-School

Accounts Receivable:  Experience In-School

Accounts Payable:  Experience In-School

Payroll / Payroll Taxes:  Experience In-School

Collections:  Experience In-School

ICD-9 Coding & Abstraction:  Experience In-School

CDT Coding & Abstraction: Experience In-School

Dental Insurance Billing: Experience In-School

Phone Triage: Experience In-School

Vitals: Experience In-School

Patient History: Experience In-School

Equipment Sterilization: Experience In-School

Cleanings & Fluoride Treatment: Experience In-School

Plaster models: Experience In-School

Impressions: Experience In-School

Four-Handed Dentistry: Experience In-School

Full Mouth & Panoramic X-ray: Experience In-School

Digital X-Ray: Experience In-School

CDA: Yes No

EFDA: Yes No

EFODA: Yes No

Software - mark all that apply (To select Multiple press ctrl and click on the programs: Dentrix Eagle Soft Windows XP or Vista QuickBooks Pro Microsoft Word Microsoft Excel Microsoft Access Other EMR / Practice Managaer Software

PREVIOUS EMPLOYMENT

Are you currently employed? Yes No

List most recent/current first: *do not exclude any employer*

Employer #1:

Start Date:                            End Date:

Start Wage:                          Ending Wage:

Title:

Phone Number:

Duties:

Reason for Leaving: (if terminated, list reason given)

Employer # 2:

Start Date:                            End Date:

Start Wage:                          Ending Wage:

Title:

Phone:

Duties:

Reason for Leaving: (if terminated, list reason given)

Employer # 3:

Start Date:                            End Date:

Start Wage:                          Ending Wage:

Title:

Phone:

Duties:

Reason for Leaving: (if terminated, list reason given)

Have you been terminated from a job not listed above?

Yes No

Have you left a position without a two-week notice?

Yes No

Have you ever been convicted of a crime (including major traffic) or have a pending case?

Yes No

If so, explain:

CERTIFICATION:

By submitting the application above, you state that all of the above answers are true and accurate to the best of your knowledge. You understand that any false information and/or statements are grounds for immediate termination, in the event employment is offered.

You authorize MVPs to conduct reference checks on your employers, less current employer, stated above. You agree to release Mid-Valley Placement & Staffing, Inc. and any employer acting under this certification from liability.

You understand that MVPs is a employment service. You understand that we will attempt to place you on a job to which you qualify for, however, you further understand, we do not guarantee employment to anyone.

I have read and agree to the above statements. I am signing this electronically by providing my last 4 digits of my SSN.

Last 4 of SSN: