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If you are interested in submitting your application for employment with Children's Dental Care please fill out the form below and submit it to us or you may print it out and fax it. Our fax number is 972.234.4562.

Today's Date:


Your Full Name:



Your Home Address:
Please include city, state and zip code


Home Phone Number:


Current Work Number:


Social Security Number:


Work Experience:
Please list in the following manner... employer, employer address, employer phone number, position held, dates employed and reason for leaving.












please check highest level completed.

High School
Some College
Business or Trade School


What year did you graduated from high school:


If You have a College Degree what do you hold:


Year you graduated from college:


Name and address of College, University or Trade School:


List awards and achievements earned:


List Valuable skills or certifications that you have:


Please list your dental skills:


Please list your office skills:


Employment Interest:

Full Time
Part Time


Specific days you can work:
check all that apply

Monday Tuesday Wednesday
Thursday Friday Saturday


Specific hours you can work:



Please list any health limitations you may have:


Are you willing to study and train:

Yes No


Are you willing to work some Saturday hours:

Yes No


Are you willing to do office work:

Yes No


Position you are applying for:


Last monthly salary:


Salary desired:


Have you ever been in an emergency situation? If so please explain the situation and how you handled the emergency:


Please list any other qualifications or comments here:


Thank you for filling out the application.