Please fill out the application form below for employment consideration. Alternatively, download and fill out our application before sending it back via email. Feel free to contact us with any questions.

Application for Employment

MM slash DD slash YYYY
Name(Required)
Address(Required)
Are you a United States citizen?(Required)
Are you legally permitted to work in the US?(Required)
Has your driver's license ever been suspended or revoked?(Required)
Have you ever been convicted of a crime?(Required)
If hired, your duties may include the handling of money. Will you give permission for a background and/or credit check?(Required)
Are you certified by the State of South Carolina to take dental radiographs?(Required)
Are you CPR certified?(Required)
Have you been vaccinated for Hepatitis B?(Required)
Work Availability(Required)
MM slash DD slash YYYY

Employment History

Are you currently employed?(Required)
May we contact your current employer?(Required)

Please start with your most recent employer.

Address(Required)
Supervisor(Required)

Address
Supervisor

Address
Supervisor

Education

Are you a high school graduate?(Required)
Equivalency or G.E.D.?(Required)
Address of educational facility(Required)

Address of educational facility

Address of educational facility
Are you currently enrolled in courses?(Required)

References

Name
Name
Name

Kotz Endodontics is an equal opportunity employer and will not discriminate against any person based on race, religion, national origin, or sex in violation of Title VII. Kotz Endodontics prohibits discrimination against employees and applicants for employment based on age, color, disability, marital status, national origin, race, religion, sex, sexual orientation, or veteran’s status.

Kotz Endodontics does not offer guaranteed employment. Either Kotz Endodontics or the employee can terminate the employment relationship at any time—with or without cause or notice.
I hereby certify that the answers given by me to the foregoing questions are full and true to the best of my knowledge and belief. I understand that any fraudulent information provided can lead to disciplinary action, up to and including termination of employment.