Doctor Candidates Doctor Candidates Basic InformationSalaryExperience Basic InformationFirst NameLast NameMobile PhoneEmail AddressWhat is your area of speciality? General Dentist Pediatric Orthodontist Oral Surgeon General dentist practicing pediatricCandidate is looking for Full-time Part-time Locum TenensHow many days / week do you wish to work?Average monthly production numbers (if applicable)List the procedures in order of proficiencyList the lab(s) that you work withInterview DateWhere do you currently reside?Are you willing to relocate? Yes NoIf yes, please list the city and states in priority orderPreviousNextSalaryDaily Rate Guarantee, Amount?% of Production% of CollectionsWhat benefits are important to you? Medical Dental Vision Malpractice CEPreviousNextExperienceIn which states / countries are you currently licensed to practice?Do you have any past or pending disciplinary actions or license suspension? Yes NoIf yes, please explain the situation and the outcomeDo you currently work in a Private Practice or DSO? Private Practice DSODo you have hospital credentials? Yes NoIf yes, where are the credentials for?What is your current contractual obligation to give notice or resign?If you are still in dental school / residency, when is your expected graduation date?Have you completed an internship / externship? Yes NoIf yes, where was the internship / externship?What board exams have you successfully completed?Do you have any other certifications / qualifications that you would like us to be aware of?What practice management software(s) have you been trained to use? Dentrix Eaglesoft Softdent Open Dental OtherWhat system(s) are you experienced in? CAD CAM Digital X-Rays Invisalign or Clear Aligner Certified Implant Placement OtherAdditional details about the systems above that would be helpful to know?Do you require an employee sponsorship for H1B or Visa? Yes NoIf you currently have an H1B or Visa, when does it expire?What languages do you read / write fluently?Do you have friends or peers who are looking for associate positions that you can recommend for us? Name / Title of who completed this formFirst NameLast NameTitleCV UploadCHOOSE FILE SUBMIT INFORMATION Previous
