Apply to Join Our Team, AA_WPForms – Lake Forest Pediatric Dentistry

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Apply to Join Our Team, AA_WPFormsDrJoe2021-01-31T05:16:21-06:00

Thank You for Your Interest in Joining Our Team!

Complete all fields marked with an *.

If you are unable to upload your resume, you may email it to us.

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Name *

First

Middle

Last

Email *

Cell Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Last 4 digits of Social Security # *

Employment Desired *

Full-Time Only
Part-Time Only
Full- or Part-Time
Internship

When would you be able to begin your employment? *

Hours you are available for work (please be specific, am to pm) *

Monday *

Tuesday *

Wednesday *

Thursday *

Friday *

Do you enjoy working with children? (1 being a defintite No, and 10 being a definite Yes) *

1
2
3
4
5
6
7
8
9
10

Do you enjoy working with special needs children? *

1
2
3
4
5
6
7
8
9
10

Do you enjoy working with anxious or strong-willed children? *

1
2
3
4
5
6
7
8
9
10

Does the sight of blood bother you? *

No
Yes

Do you require any special accommodations to complete the major functions of this position? *

No
Yes

Special Accommodations

Languages that you speak fluently *

How many words per minute do you type? *

How did you hear about employment opportunities with our practice? *

One of Our Team
One of our Patients
Indeed
LinkedIn
Other

Team Member Referral

Patient Referral

Education

High School *

HS City,State *

HS Yrs *

College

College Yrs

College Major & Degree

Business or Trade School

Yrs

Major & Degree

Professional School

Prof School Yrs

Prof Degree

Employment Experience

Please list your work experience for the past 5 years or more beginning with your most recent.

Employer 1

Emp City, State

Job Title

Super

Dates

Start Salary

End Salary

Reason for Leave

Employer 2

Emp City, State

Job Title

Super

Dates

Start Salary

End Salary

Reason for Leave

Employer 3

Emp City, State

Job Title

Super

Dates

Start Salary

End Salary

Reason for Leave

Employer 4

Emp City, State

Job Title

Super

Dates

Start Salary

End Salary

Reason for Leave

May we contact your present and past employers? *

Yes
No

Contact Employers

Have you ever served in the armed forces? *

Yes
No

Military Branch(es) & Rank(s)

Do you have a valid driver's license? *

Yes
No

What is your means of transportation to work? *

Please list 2 references other than relatives or previous employers.

Reference 1 *

Reference 1 Phone *

Reference 1 Employer

Reference 1 Position

Reference 2 *

Reference 2 Phone *

Reference 2 Employer

Reference 2 Position

Describe your level of comfort with computers, including which operating systems you are familiar with as well as your proficiency with specific software programs. *

Use this space for additional information about yourself, including that which may pertain to your qualifications for this position.

Please Upload Your Resume Here

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By pressing the Submit button below, you are acknowledging that this application was completed by yourself, and all information is truthful. You are also granting us permission to contact schools, previous employers (unless otherwise indicated), references and others, and hereby release this office from any reliability as a result of such contact.

One Doctor, One Location, One Focus:
Your Child’s Dental Health, Comfort & Safety

500 N Western Ave
Suite 215
Lake Forest, IL 60045

(847) 482-1900

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(201) 355-3400

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