Present Client Job Order Form

Please submit the following information and we will be in contact with you soon!

Please provide the following contact information:

Name

Business Name

Office Address

Address (cont.)

City

State

Zip Code

Work Phone

FAX

E-mail

Date: -- mm/dd/yy

Type of Practice:

I am looking for:

Days and Hours Required:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Additional Days and Hours:

What dental software should applicants be familiar with?

Is this information confidential?

Yes
No

Please provide the following confidential contact information:

Name

Job Title

Direct Phone

Comments:

618 Southbridge Blvd Savannah, GA 31405 = 800-438-7470 office = 912-234-5544 fax = 912-596-7660 mobile
info@palmettodentalpersonnel.com
Palmetto Dental Personnel, Inc. follows all EOC laws.

Dental Assistant	Temporary
Dental Hygienist	Permanent
Prophy Assistant	Full Time
Receptionist	Part Time
Management

Dentrix	Softcense
Dexis	Softdent
Eagle Soft	Other
Easy Dental

Name
Business Name
Office Address
Address (cont.)
City
State
Zip Code
Work Phone
FAX
E-mail