Applicant Information

    Position Applying For (Check all that apply)

    Office Location(s) (Check all that apply):

    Employment History

    (Please list your last three employers, starting with the most recent.)

    Employer 1

    Can we call for reference?

    Employer 2

    Can we call for reference?

    Employer 3

    Can we call for reference?

    Education & Certifications

    Are you a Texas Board- Registered RDA, RDH

    Are you Texas Board-Certified for N2O administration?

    Are you current with CPR requirements?

    Have you had Hepatitis vaccine?

    Do you smoke?

    Skills & Experience

    Comfortable with entering treatment information on a computer?

    For Registered Dental Assistants

    Experience with using digital radiography?

    Experience with using digital Scanners?

    Able to place rubber dam?

    Able to take x-ray with rubber dam in place?

    Able to make temporary crown?

    Able to pack cord?

    Able to place Tofflemire matrix?

    Background Information

    Have you ever been arrested or convicted of a felony?

    (Disclosure will not necessarily disqualify you for employment consideration. All circumstances will be considered.)

    Have you ever been accused of, or charged with, discrimination and/or harassment at the place of employment against anyone on the basis of race, sex (including sexual harassment and same-sex harassment), age, religion, disability, color, national origin, veteran’s status, sexual orientation or any other basis prohibited by law. If yes, please explain the circumstances and the disposition?

    Equal Opportunity Employment

    Bravo! Dental is an equal opportunity employer. We are committed to providing a workplace free of discrimination and harassment based on race, color, religion, sex, national origin, age, disability, marital or veteran status, or any other protected status. Employment decisions are based on qualifications, merit, and business needs. Reasonable accommodation can be provided for qualified individuals with disabilities, as long as they do not compromise the essential duties and tasks required for the position.

    Agreement

    • I certify that all information provided is true and correct to the best of my knowledge. I understand omissions or misrepresentations may be the cause for rejection or dismissal. I authorize Bravo! Dental to contact all sources necessary to verify this information and hold harmless Bravo! Dental and those providing information.

    • I understand that issuance of this application does not indicate that there are any positions open and does not in any way obligate the company. If employed, I agree to comply with all policies and procedures of the company as a condition of continued employment. Furthermore, my employment shall be at-will and may be terminated at any time upon notice by me or by the company.

    • I will regard and preserve as confidential, and will not divulge to unauthorized persons any information, matter, or things of a secret, confidential, or private nature connected with the business or employees of the company.

    • I understand that a background check is mandatory before employment consideration, and any offer extended to me will be contingent upon successful completion.

    • I understand that when reporting to work, I will furnish proof to legally work in the United States.

    Interview Commitment Agreement

    By submitting this application, I acknowledge that scheduling an interview is a commitment. If I am unable to attend my scheduled interview for any reason, I agree to notify Bravo! Dental as soon as possible and at least 24 hours in advance, unless an emergency prevents me from doing so. Failure to attend a scheduled interview without prior communication may result in disqualification from current and future employment opportunities with Bravo! Dental.

    Agreement & Signature

    WE WANT YOU!

    Download PDF form and send your application form and resume by