Application For Employment

By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our patients and contributing to the success of the organization. All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, severe/morbid obesity, medical condition, military/veteran status, genetic information, marital status, ethnicity, alienage or any other protected classification, in accordance with applicable federal, state, and local laws. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.

Personal Information

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please enter a valid phone number.Format: (000) 000-0000.

Employment History

List below all present and past employment starting with your most recent employer (last five years is sufficient). You must complete this section even if attaching a resume. Employer will not contact a current employer unless indicated as acceptable.

Please describe your educational background in the table provided below

College/University

Graduate/Professional School

Trade School/Other

Professional & Personal References

Please list three professioanl references of indivituals who are not related to you.

Please enter a valid phone number.Format: (000) 000-0000.

Please list two personal references of individuals whom you would like us to contact on your behalf

Please enter a valid phone number.Format: (000) 000-0000.

I hereby authorize Canyon Crest Dental, as allowed by law, to thoroughly investigate my references, work record, education and othe matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to Canyon Crest Dental any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Canyon Crest Dental, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.*

In the event of my employment with Canyon Crest Dental, I understand that I am required to comply with all rules, regulations and policies of the Company. *

If hired, I understand and agree that my employment with Canyon Crest Dental is at-will, and that neither I, nor Canyon Crest Dental is required to continue the employment relationship for any specific term. I further understand that Canyon Crest Dental or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications. *

I understand that safety of employees is extremely important to Canyon Crest Dental and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health. *

I understand that if I am aware that I am unable to perform the essential functions of the job for which I am applying, I shall make that information known to Canyon Crest Dental prior to accepting an offer of employment. *

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an 1-9 Form in this regard. *

In accordance with Labor Code 432.3, I hereby certify that Canyon Crest Dental has not, orally or in writing, personally or through an agent, sought salary history information, including compensation and benefits, at any point during this application process. Any relative information which has been shared was done so voluntarily. *

I understand that if I am selected for hire that Canyon Crest Dental will ask that I complete the pre-employment process for the position for which I am applying. I understand that Canyon Crest Dental shall ensure that all pre-screening and employment tests conducted are applied evenly and are properly validated for the positions and purposes for which they are used. I further understand that any tests or other selection procedures employer administers will be done impartially and without regard to race, color, national origin, sex, religion, or any other characteristic or status protected by federal, state or local law. *

I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable. *

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.*

MY SIGNATURE BELOW ATTESTS TO THE FACT THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL OF THE ABOVE TERMS.

Applicant Statement and Agreement