DDS Staffing Resources Inc Dogwood Road Suite Roswell Georgia Thank by carlmartin


									                           DDS Staffing Resources, Inc.
                           9755 Dogwood Road, Suite 200
                           Roswell, Georgia 30075                                             Thank You For Helping Us Serve You Better!
                                   (770) 998-7779                                             Your evaluation is vital to us in providing you
Timesheet Fax Number:                                                                         with skilled temporary employees.
(770)640-5188 or (678)242-0053                                                                DENTIST PERFORMANCE APPRAISAL
Terms And Conditions                                                                          Office Name:
As an authorized representative of the Company, I understand that this contract
authorized DDS Staffing Resources, Inc. to invoice this practice for the services of the      Employee:
temporary dentist at a pre-established billing rate for this classification for the hours
recorded on this document. Billing is weekly and payment is due upon receipt of this          Date of Service:
invoice. I understand that no direct payment is to be made to the temporary dentist. I
further understand that this invoice will be considered in default after thirty (30) days     CONFIDENTIAL                                 Please Circle
from the postmark of the invoice. Additionally I understand that in such instance I will be
liable for a default charge of TWO (2) PERCENT PER MONTH OF THE UNPAID                            1.   Did
I understand that the below named dentist is not an employee of DDS Staffing Resources,                arrived on time ?                   YES       NO
Inc. but an independent contracted professional whose services are offered to this practice
as part of contracted services rendered by DDS Staffing Resources, Inc. It is understood          2.   Would you request this dentist
that DDS Staffing Resources, Inc. is not qualified to certify the qualifications of any                again as a temporary dentist ?      YES       NO
dentist but only warrants that the state has indicated the below named dentist is currently
licensed in good standing in the state where services are offered. I understand that should
I desire to hire this dental professional either directly or indirectly for permanent,
                                                                                                  3.   Were you pleased with his/her
temporary or part-time employment, I agree to notify DDS Staffing of this offer and I                  professional appearance ?           YES       NO
also agree to notify DDS Staffing if this Dental professional purchases the practice and I
understand that I will be invoiced by DDS Staffing for a finders fee at the current rate. I       4.   Are you satisfied with
agree that this company shall also be obligated to these requirements for a period of one
(1) year following the termination of this assignment. I understand that no insurance is
                                                                                                       DDS Staffing Resources, Inc.?       YES       NO
afforded by DDS Staffing Resources, Inc. for physical loss or damage to machinery,
equipment or materials; and that DDS Staffing shall not be held liable for physical loss or   SKILLS
damage to said property caused by the company, its agents or dental professionals. I also
accept full responsibility for claims involving bodily injury, property damage, fire, theft   How would you rate this Dentist?
or liability damages I understand that supervisory responsibility remains with me and is
not waived by virtue of the temporary's contract with DDS Staffing Resources, Inc. This       Not applicable                                NA
agreement provides authorization to communicate with your practice through fax and/or
email correspondence. Twenty-four (24) hour cancellation policy: There is a four (4)          Excellent                                   5 points
hour minimum charge for any job order canceled 24 hours or less prior to confirmed            Very Good                                   4 points
                                                                                              Good                                        3 points
□ Direct Deposit □ TOTALPAY Card                                                              Fair                                        2 points
OFFICE NAME AND ADDRESS                                                                       Poor                                        1 point
Street:                                                                                       1. Knowledge of clinical procedures
City:            State:      Zip:                                                             2. Telephone Techniques
Telephone:                                                                                    3. Communication/people skills
Fax:                                                                                          4. Quality of work
Temporary Dentist Name:                                                                       Please comment on any strong or weak points:
City:                   State:                                  Zip:
              Mon Tue Wed Thu                                  Fri      Sat
  Finish                                                                         Total
  Time                                                                           Hours
  Time Taken                                                                     For The
  For Lunch                                                                      Week
I certify that the hours shown above represent the total time worked on the assignment
during the week indicated, that I am to notify DDS Staffing Resources, Inc. and that I
must return this signed form upon completion of this agreement.

Temporary Dentist must sign
As a duly authorized representative of this office, I agree to the Terms and Conditions
outlined above and I certify that the hours shown above are correct and that the employee
performed satisfactorily.                                                                     Authorized Signature:

Doctor's signature
BR_______                             PR_______
Step-by-Step: How to complete                            1. Ask the practice doctor or supervisor to
Employee Performance Evaluation:                            sign the terms and conditions upon
                                                            arrival at the office.
    1. Upon arrival in the office, please detach
                                                         2. Completely fill out all information in the
       evaluation form from the timesheet. Fill-
                                                            office and employee section.
       in name of the person you are reporting
       to on 1st line.                                   3. Record the date(s) and hours worked in
    2. Write your name after                                the appropriate area.
       "Employee:                              "
                                                         4. Add up total hours worked. Remember to
    3. Give this form to your supervisor.
                                                            subtract time taken for lunch and enter
                                                            amount in "totals" column.
                                                         5. Have the supervisor at the assignment
Please complete this evaluation and return it to            sign the timesheet to verify hours workd
our office. Evaluations can be faxed to us at:           6. Sign your name on the employee
                                                            signature line.
             (770) 552-0176
                                                         7. Fax, mail or drop off timesheet no later
            or mail them to us at:                          than Monday at 5.00 p.m. The accounting
         DDS Staffing Resources, Inc.                       fax number is: (678) 242-0051.
            9755 Dogwood Road
                  Suite 200                          Payroll is either Direct Deposit or TotalPay Card.
            Roswell, GA 30075                        Please check the correct option on the front of
                                                     your timesheet.
We appreciate your comments and suggestions
                                                     All questions concerning payroll or timesheets
regarding our temporaries. Your input enables us
                                                     should be directed to Diana in our accounting
to continue providing quality candidates for all
your staffing needs.
If you have any questions or suggestions                    (770) 998-7779 Ext. 109
regarding the evaluations or any other matter,                    Thank you!
please feel free to contact our office and ask for
Michelle Lee at extension 101 (770) 998-7779.

Again we thank you for your
comments and we thank you for
your business!

Step-by-Step: How to complete your

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