Home Page Dental Hygienists, Dental Assistants and Dental Front Office
Sep 18, 2019
Quality Staffing Solutions for Dental Professionals in Utah
Dental Staff Information

Thank You for choosing Rocky Mountain Dental Staffing, Inc.

Complete the form to the right to Apply for work with Rocky Mountain Dental Staffing. All of your information is confidential and upon receipt of your application we will contact you with additional instructions.

If you have any questions about this form, please feel free to contact us.

*indicates required field

First Name:*

Last Name:*
Home Phone:*

Cell Phone:

Email Address:*
Street Address:*

Date of Birth:*

Social Security Number:*
Employers must have your SSN on file to employ you. For security purposes additional information will be e-mailed to you.
Hygiene License #:*
Is your license current?    
Where are you currently employed?
What is your current pay rate?
How far are you willing to travel?
Employment Information

Please select the position you are applying for:


Please list your work experience:

Please list your educational experience:

Terms and Conditions:

I agree that the above information is true and correct. I also agree when working through Rocky Mountain Dental Staffing, Inc. (RMDS), I will report any additional days worked for any doctor. I agree that all scheduling of temporary placement, permanent placement, interviews and working interviews are conducted only through RMDS Inc. and the Dental Office. If solicited by anyone at a Dental office for employment it is your responsibility to notify a coordinator at RMDS. Failure to do this will preclude RMDS from using me in the future and will also carry a fine. Further, I recognize that it is also my responsibility to report permanent positions that have been offered to me. I also understand that personnel provided by RMDS shall be employees of the doctor and not of RMDS.

I accept the above terms Yes No


By submitting this form, I certify that the statements made in answers to the questions are true, complete and correct to the best of my knowledge.