Register to be a Temp Please use the below form to apply to become part of the Temp Dental team Name: Email Address Dental Hygenist, Dental Assitant or Front Desk NZ Dental License number Home address City Region Zip Code IRD number Phone Number University Attended Year Graduated Days/Hours available to work Specialties Do you have any physical limitation or consideration that would interfere with you duties in the position as a Dental Hygienist or Dental Assistant? If so, please explain: PRESENT/FORMER EMPLOYERS DATES: May we contact your former employees? Have you had your hepatitis B Vaccination? I certify that the above information is true and correct. I authorize investigation of all data provided. I understand any false information on this application will be sufficient cause for dismissal from Temp Dental. I certify that I am legally authorized to work in New Zealand and I will provide documentation supporting such eligibility: Enter your full legal name if you answered yes to the above statement: Submit Δ