Title
     Mr. Ms. Dr.

First Name

Last Name

Address

City

State
Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareColumbia (District of)FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip

Home Phone

Cell Phone

Work Phone

Email Address

I am interested in
     Part Time Employment (Less than 40 hours/week) Full Time Employment (40 hours/week) Part or Full Time Employment

I would consider temporary/short term positions
     Yes No Possibly

Profession
     Dental Assistant Dental Lab Technician Dental Hygienist General Dentist Endodontist Oral Surgeon Orthodontist Periodontist Prosthodontist Other – please note in comments section.

Profession Comments

Salary Expectation – DPS requests your annual salary expectation for market research purposes in order to ensure that we continue to offer competitive compensation packages.
     $25,000 – $29,000 $30,000 - $34,000 $35,000 - $39,000 $40,000 - $49,000 $50,000 - $59,000 $60,000 - $69,000 $70,000 - $79,000 $80,000 - $89,000 $90,000 - $99,000 $100,000 - $114,000 $115,000 - $129,000 $130,000 - $149,000 $150,000 - $179,000 $180,000 - $209,000 $210,000 - $249,000 $250,000 - $290,000 $300,000 +

Work Experience
     Less than 1 year 1 – 2 years 3 - 5 years 6 – 10 years 11 – 15 years 16 – 20 years 21+ years

Last date practiced in a clinical setting

State of Licensure 1
Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareColumbia (District of)FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

State of Licensure 2
Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareColumbia (District of)FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

State of Licensure 3
Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareColumbia (District of)FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Describe any qualifications or special training that you wish to bring to our attention

Are you willing to relocate?
     Yes No

I am interested in working in the following locations:

Work Sites 1
     Camp Pendleton/Miramar, CA Lemoore, CA Monterey, CA Point Mugu/Port Hueneme CA San Diego, CA Twenty-nine Palms, CA Jacksonville, FL Key West, FL Mayport, FL Pensacola, FL Kings Bay, GA FHCC Lovell, Chicago IL Belle Chase, LA New Orleans, LA U.S. Naval Academy Annapolis, MD Andrews AFB, MD Dalgren, VA/Indian Head, MD Patuxent, MD Camp Lejeune, NC Cherry Point, NC Newport, RI Beaufort, SC Norfolk/Portsmouth, VA Quantico, VA Bremerton, WA Oak Harbor, WA

Work Sites 2
     Camp Pendleton/Miramar, CA Lemoore, CA Monterey, CA Point Mugu/Port Hueneme CA San Diego, CA Twenty-nine Palms, CA Jacksonville, FL Key West, FL Mayport, FL Pensacola, FL Kings Bay, GA FHCC Lovell, Chicago IL Belle Chase, LA New Orleans, LA U.S. Naval Academy Annapolis, MD Andrews AFB, MD Dalgren, VA/Indian Head, MD Patuxent, MD Camp Lejeune, NC Cherry Point, NC Newport, RI Beaufort, SC Norfolk/Portsmouth, VA Quantico, VA Bremerton, WA Oak Harbor, WA

Work Sites 3
     Camp Pendleton/Miramar, CA Lemoore, CA Monterey, CA Point Mugu/Port Hueneme CA San Diego, CA Twenty-nine Palms, CA Jacksonville, FL Key West, FL Mayport, FL Pensacola, FL Kings Bay, GA FHCC Lovell, Chicago IL Belle Chase, LA New Orleans, LA U.S. Naval Academy Annapolis, MD Andrews AFB, MD Dalgren, VA/Indian Head, MD Patuxent, MD Camp Lejeune, NC Cherry Point, NC Newport, RI Beaufort, SC Norfolk/Portsmouth, VA Quantico, VA Bremerton, WA Oak Harbor, WA

Other states/locations I am interested in working at

I am currently
     Active Duty Military Government Service (GS) Government Contractor Employee Independent Contractor Owner of private practice Employed in private practice Unemployed Retired In school/training Other employment

Additional Comments

Attach your resume

How did you hear about us?
     Internet search Friend/coworker Military clinic/installation Training school web site Job opportunity web site Professional journal Newspaper Other

If other, how?