Thank you for your interest in registering with RDH Temps! To begin the application process, please fill out the short form below:

General Information:

First Name:

Last Name:

Previous Last Name:

Email:

Primary phone number:

Mobile or secondary phone number:

Mailing address:


City:

State:

Zip:


Have you ever registered with RDH Temps before?
Yes
No
Not Sure

How did you hear about RDH Temps?


What type of position are you seeking?:
Dentist
Dental Hygienist
Dental Assistant
Administrative
Other

Are you legally able to work in the United States?
Yes
No

Are you able to provide proof of U.S. work eligibility (such as a Social Security Card, United States Passport or Permanent Resident Card?)
Yes
No

Are you interested in a particular job opening we have listed?
Yes
No

If so, what is the RDH Temps job number?


Which days are you available for temporary work?:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Which days are you available for a permanent job?:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

How many years dental office experience do you have?


Is your dental office experience within the past 5 years?
Yes
No

Where did you receive your dental education?
School: Graduation year:
School: Graduation year:

Dental Assistants Only:

Are you currently a CDA?
Yes
No

If not, were you previously a CDA?
Yes
No

Are you Radiology Certified?
Yes
No

If so, are you able to provide documentation to support Radiology Certification?
Yes
No

Do you have more than one year of experience in an orthodontic office within the past 5 years?
Yes
No

Dental Administrative Personnel Only:

Please list your Dental Computer Software experience below:
Software: Experience: Years Months
Software: Experience: Years Months
Software: Experience: Years Months

Additional comments or questions: