Springville Dentistry is looking for dedicated and compassionate professionals to help patients feel welcome and comfortable as they assist doctors in performing their functions efficiently and effectively.

If you are highly motivated to complete multiple tasks quickly, looking for an opportunity to advance in your dental career, enjoy challenging yourself with new technologies, and can be a dependable team member, please fill out the application below.

Personal Information

First Name

Last Name

Phone Number

Best Email

Current Address

Suite/Apt #

City

State

Zip Code

Are you legally eligible to work in the US?

Yes No

If selected for employment will you submit to a background check?

Yes No

Current Open Positions

Desired Position

Available Start Date

Pay Requested/hour

Employment Schedule

Full-Time Part-Time

Education

1. School Name

1 School Location

1. Dates Attended

1. Degree/Certificate Received

1. Specialty (optional)

2. School Name:

2. School Location

2. Dates Attended

2.Degree/Certificate Received

2. Specialty (optional)

Reference (business and professional references only)

Reference Full Name

Reference Job Title

Reference Company

Reference Phone

Employment History

1. Employer Name

1. Your Job Title

1. Dates Employed

1. Employer Address

1. Employer City

1. Employer State

1. Employer Zip Code

1. Employer Phone No.

1. Start Rate of Pay

1. End Rate of Pay

2. Employer Name

2. Your Job Title

2. Dates Employed

2. Employer Address

2. Employer City

2. Employer State

2. Employer Zip Code

2. Employer Phone No.

2. Start Rate of Pay

2. End Rate of Pay

Upload Your Resume (*optional) (*maximum size 5MB) (*approved formats: .pdf, .doc, .png, .jpg)

Upload A Photo (*optional) (*maximum size 5MB) (*approved formats: . gif, .png, .jpg)

Message (*optional)

Disclaimer/Acceptance

Acceptance Is Required

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my employment being terminated.

Your First Name

Your Last Name

Submission Date

We are an equal-opportunity employer. Discrimination due to race, sexual orientation, and age is not tolerated within our organization.

Employment Application

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