LTO Cover Letter

EMPLOYMENT APPLICATION QUESTIONAIRE

Name:______Date: ______

Address: ______

Home Phone Number: ______Cell Phone # ______

E-mail address: ______

Phone number that we can personally contact you at? ______

Desired Position: ______Salary Desired: ______

Education History: High School ______Last Grade Completed: ______

College, Trade School or Special Training Courses: ______

Did you receive your degree? _____ If so, what is your degree? ______

Are all required certifications current? ______Are you available to do a working interview? ______

EMPLOYMENT HISTORY: (START FROM PRESENT OR LAST POSITION)

Employer: ______Position Held: ______

Address: ______

Phone Number: ______From: ______To ______

Reason for Leaving: ______

Employer: ______Position Held: ______

Address: ______

Phone Number: ______From: ______To ______

Reason for Leaving: ______

Employer: ______Position Held: ______

Address: ______

Phone Number: ______From: ______To ______

Reason for Leaving: ______

3-5 REFERENCES: EXCLUDE RELATIVES

Name/TitleAddress & Phone NumberRelationship to you

______

REFERENCE RELEASE

I authorize (“the Company/Practice”)

or its representatives to provide any and all information concerning my former employment.

Dates of employment□ Confirm salary information

Reason for employment separation□ Job title

Quality of performance□ Attendance and punctuality

Other (describe) ______

Further, I release all parties from any and all liability for any damages that may result from furnishing such information to a potential employer, as well as from the use or disclosure of such information by the Company, or any of its agents, employees, or representatives.

This release is in effect until I rescind it, in writing, and notify the Practice.

Signed: Date: ______

Print Name:

Witness Signature: ______Date: ______

Interview Questions for a Hygienist

1. Describe your Periodontal guidelines?

2. What is your experience with computers in the treatment rooms?

3. What dental computer software have you been trained on and what level is your experience?

4. What type of continuing education have you had?

5. How often do you think x-rays should be taken?

6. How would you handle a nervous patient?

7. If a patient questioned you about the doctor’s ability to do treatment, what would you say/do?

8. If you were running behind in the schedule by 10 minutes what would you tell the business team to say to your next patient?

9. Have you worked in a practice that subscribed to interceptive periodontal therapy?

If so, to what extent?

10. Are you willing to participate in team meetings even they are held on a day that you do not normally see patients?

11. Are you willing to attend CE courses that the office would be attending at a non-hygiene wage?

12. Do you prefer to be paid an hourly, daily, salary or commission rate?

13. How do you feel about performing a whitening procedure during your chair time?

14. Do you feel it is your responsibility to take blood pressure, review medical health history, give home care instructions and take x-rays each visit or should that be delegated to either an assistant or a hygiene assistant??

15. How do you feel about the use of ultrasonic scalers?

16. How do you feel about performing sealants?

17. What role does the hygienist play in increasing productivity?

18. If our production dropped off, what would you do to try to correct this situation?

19. What is your experience with using an intraoral camera?

20. How would you promote the practice outside of the office? What would you say?

21. How do you feel about placing antimicrobials? Do you feel they have value for the patient?

22. If you had a broken appointment, what would you do?

23. How do you feel about “selling” the doctors treatment plan to the patient?

24. How much time do you prefer to have scheduled with your prophy patients and Perio quadrants?

25. Who do you think is responsible for the recall system and why??

PLEASE IDENTIFY THE MISSPELLED WORDS BY WRITING THE CORRECT SPELLING ON THE LINE

______1. deninsty

______2. orral surgueon

______3. amalgam

______4. bonding

______5. bleeching

______6. restoration

______7. floride

______8. conposite

______9. statment

______10. hgyienist

______11. prophylaxis

______12. accounts recievable

______13. wisdon teeth

______14. intraoral

______15. procalean

______16. cuspid

______17. x-rey

______18. plague

______19. emplants

______20. arrangments

______21. accounts

______22. dentition

______23. schedualed

______24. gingavitis

______25. clincal

______26. bridgework

______27. priodontal

______28. orthodontest

______29. treatment

______30. apointment