Dentist Candidate Form
Please Enter The Details Below
First Name
*
Last Name
*
Phone/Mobile
*
Email
*
Spoken to
What are your areas of interest or specialty in dentistry?
*
Interests or specialties
General Dentistry
Orthodontics
Prosthodontics
Periodontics
Endodontics
Cosmetic Dentistry
Dental Implants
Oral and Maxillofacial Surgery
Pediatric Dentistry
Oral Medicine and Pathology
Dental Public Health
Dental Anesthesiology
Oral Radiology and Imaging
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Which dental facilities are you open to working at?
*
Select all that apply
Private dental practices
Public dental clinics
Dental hospitals
University dental clinics
Community health centers
Mobile dental clinics
Other
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How many years experience do you have?
*
Please share
less than 3 years
more than 3 years
more than 5 years
more than 10 years
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Do you have any working restrictions in Australia?
What pay type are you looking for?
*
e.g. hourly rate, percentage of billings
Hourly rate
Daily rate
Annual salary
Percentage of billings
Base plus commission
Any
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What is your ideal pay range or percentage range?
What is your preferred Suburb?
What is the maximum commute time or distance you would consider?
What is your availability? i.e. when could you start?
*
Please select
Immediately
1 Week
2 Weeks
4 Weeks
6 Weeks
3 Months+
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Work type
*
e.g. FT, PT or Locum - select all that apply
Full-time
Part-time
Locum
Any
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How many patients per day do you wish to see?
*
Please select
1-5
5-10
10-15
15-20
20-25
25+
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Any preference on patient population? i.e. children, elderly, specific demographic
Do you have any plans for ongoing professional development or education?
What are some of your personal interests? E.g. Hiking, Sports, Family time
What is the most important factor that would get you to consider a new role?
Please select
Money
Location
Patient Volume
School hours
Work / life balance
Flexibility
Specialist Area of Practice
Demographic
Practice Culture
Professional Development
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Is there anything else important to you?
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