CaReers Home Careers Looking for a career at Heroes Dental? Please submit all resumes to careers@heroesdental.com. EMPLOYEE APPLICATIONPosition applying(Required) Last Name(Required) First Name(Required) Middle Initial DOB(Required) Address(Required) City(Required) State(Required) Zip(Required) Home Phone(Required) Cell Phone Email(Required) Are you 18 years or older?(Required) Yes No Salary/hourly Rate Desired Employment desired Yes No When Can You Start? Are you legally permitted to work in the United States? Yes No Are you currently Employed? Yes No If yes, why would you wish to make a change?May we contact your present employer? Yes No Have you ever been convicted of any crime? (List all except minor traffic violations as parking tickets) Yes No If yes, please explain:Do you have experience working with dental softwares? Yes No If yes, which one(s)? EDUCATION AND TRAININGType of schoolName and location of schoolList degrees WORK EXPERIENCE Note: Start with the most recent first. (Please attach a resume in addition to filling out the following information):Present/Last Employer Type of Business Address Telephone Supervisor (Name/Position) From To Last Salary/Rate Job Title Description of Job and Duties Reason for Leaving Present/Last Employer Type of Business Address Telephone Supervisor (Name/Position) From To Last Salary/Rate Job Title Description of Job and Duties Reason for Leaving Present/Last Employer Type of Business Address Telephone Supervisor (Name/Position) From To Last Salary/Rate Job Title Description of Job and Duties Reason for Leaving ADDITIONAL INFORMATIONAdditional Information APPLICATION AGREEMENT I understand and agree that the information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification for refusal of employment or, if discovered once employed, the termination of my employment with Little Heroes Pediatric Dentistry. I authorize and request that all of my former employers, including supervisors and managers, and any other individuals I have listed as personal references, furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information.Signature Date MM slash DD slash YYYY All qualified applicants receive consideration for employment without regard to race, color, religion, gender, pregnancy, sexual orientation, age, national origin, disability, marital, veteran, or any other legally protectedstatus.
