Job Opportunities

We offer two options to apply for enrollment in our Dental Assistant Training Program.

1. Downloadable Enrollment Application
   Please use this link to download a hard copy of the current enrollment application, fill it out, print it and fax/mail it to our office using the contact information on this page.
2. Please fill out and submit this electronic enrollment application form.
   
   Personal Information

   1. First Name(required)
   2. Middle Name(required)
   3. Last Name(required)
   4. Date of Birth(required)
   5. Address 1(required)
   6. Address 2
   7. City(required)
   8. State(required)
   9. Zip(required)
   10. County(required)

   Contact Information

   1. Home(required)
   2. Work
   3. Cell
   4. Email(valid email required)
   5. Website

   Background Information

   1. Education Level (Select Highest Grade Completed) 12 = High School Graduate 13 = Adult High School Diploma/GED 14 = One Year Vocational School 15 = Associate Degree 16 = Bachelor's Degree or Higher (required)
   2. High School/GED
   3. Vocational School
   4. College

   Emloyment Information

   1. Employment Status Full-time Part-time Student Unemployed (required)
   2. Employer
   3. Occupation

   References

   1. Reference #1 Name(required)
   2. Reference #1 Phone(required)
   3. Reference #2 Name(required)
   4. Reference #2 Phone(required)
   5. Reference #3 Name(required)
   6. Reference #3 Phone(required)

   1. Verification
   2. By clicking submit, I certify that all items of this application are answered correctly and completely. I understand that providing false or incomplete information may disqualify me from admission and enrollment.

    

If you have more specific questions, please do not hesitate to Contact Us.