Request Form
Our agency provides reliable means to connect you with a rich pool of qualified candidates. Therefore, when a shortage of staff occurs, you are invited to notify Connections Dentaires that a temporary or permanent employee is needed
Sign in to Google to save your progress. Learn more
Email *
Name of the Clinic: *
Name of the doctor: *
Address: *
Contact Person: *
Name of Dental Software:
Phone number: *
Requested Personnel: *
Required
Duration: *
Required
Work Experience:
Language Capabilities:
Hours of operation:
****fill out only two boxes for duration*****
7:00
8:00
9:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Starting Date:
MM
/
DD
/
YYYY
Salary:
Personal Specifications:
Dentist's Initialize and Current Date: *
- No registration or search fees.                                                                                                                                                                           - Fees will be applicable should you select a candidate referred by Dental Connections within a 12 month period after the initial referral fees payable within 14 days of invoice.                                                                                                                             - 5% interest per month applicable on late payments.                                                                                                                               - Dental Connections acts only as a reference and holds no responsibility for the personal or professional acts of the referred candidates.                                                                                                                                                                                      - 30 day decreasing warranty applies to full and part time placements once payments have been received.
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Elena Scorogonova. Report Abuse