First Name:*

Cell Phone:
( )

Date of Birth:*
Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990

Please select the position you are applying for:

Front Office
Dental Hygienist
Dental Assistant

Dentist

Please list your work experience:

Please list your educational experience:

Terms and Conditions:

I agree that the above information is true and correct. I also agree when working through B & B Dental Temps, LLC, I will report any additional days worked for any doctor. I agree that all scheduling of temporary placement, permanent placement, interviews and working interviews are conducted only through B & B Dental Temps,LLC and the Dental Office. If solicited by anyone at a Dental office for employment it is my responsibility to notify a coordinator at B & B Dental Temps, LLC. Further, I recognize that it is also my responsibility to report permanent positions that have been offered to me. I also understand that personnel provided by B & B Dental Temps, LLC shall be employees of the doctor and not of B & B Dental Temps, LLC.

I accept the above terms Yes No