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					             TDN…The Dental Network, L.L.C
                               www.thedentalnetworkllc.net

                                                                                   573-205-8639 Office
                                                                                         P.O. Box 575,
                                                                                  Sullivan, Mo. 63080
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                              Independent Contractors Agreement


                      The Dental Network, L.L.C, agrees to contract,
                      ______________________________, at ___________/hr for performing
                      temporary dental services.

                            As of 1996, The Missouri Division of Employment Security
                      requires that temporary independent contractors be issued a 1099
                      if earnings are above $599.00. It is the sole responsibility of the
                      contracting dentist to provide those forms to you if you have
                      exceeded $599.00 annually with that one dentist. The Dental
                      Network, L.L.C is not responsible for any fees and/ or liabilities
                      that are incurred during commute or on the job with contracting
                      dentist, Including but not limited to: injuries, assaults, illness, or
                      accidents. The Dental Network, L.L.C holds no liabilities for
                      insurance or negligence and is not held responsible to do so. The
                      Dental Network, L.L.C is only a broker for the dental field.

                            SOLICITATION BETWEEN YOU AND THE DENTAL
                      OFFICE IS STRICTLY PROHIBITTED! DO NOT GIVE OUT YOUR
                      CONTACT INFORMATION. ALL INQUIRIES MUST GO
                      THROUGH THIS OFFICE. If permanent placement is wanted
                      there is a fee to be paid by the dental office requesting to
                      permanently hire you. You are required to keep the Dental
                      Network, L.L.C abreast of any solicitation or desire to be placed
                      there.             INITIAL PAGE______                       Pg. 1 of 5


The Dental Network   , L.L.C

                                                                                               1
      The dentist, at the end of your assignment, will make
payment DIRECTLY TO YOU. You are responsible to download
the time cards from our website, fill them out accurately and
return them signed and dated by all parties. Please mark that the
dentist had paid you on the total line with the check number. Do
not hold the time card. Send them back via mail or upload them to
our website.

      Do not be late to your assignment. You must be 15 minutes
early to be briefed on your responsibilities for that day. There is a
three-day cancellation policy. If notice is not given three days
prior to assignment, you will be permanently inactivated (unless it
was a medical



     By signing this contract you are stating that you are
accepting the set above terms and are required to keep accurate
records for yourself. Violation of the solicitation clause may cause
a lawsuit against you. You will be required to pay all Court cost
and fees incurred and a settlement may be granted against you.
You are also acknowledging that any violation of this contract will
cause termination of your employment with this company and the
dental office in question. Please fill in the dates that you are
available.


Position      dates       from          to      office
                                                Use




                 INITIAL PAGE______                       Pg. 2 of 5




                                                                       2
________________________________      ____________________________
Signature of temporary                 printed name

________________________________      ____________________________
Phone                                 address

________________________________
Date

________________________________
Stephanie Damron-whipple
(Ownerand CEO -The Dental Network, L.L.C)

________________________________
Date




**FILL OUT WORK HISTORY COMPLETELY. BY SIGNING THIS
FORM YOU ARE AGREEING THAT THE BELOW WORK
HISTORY, EXPERIENCE, and CERTIFICATIONS ARE TRUE
AND ACCURATE. YOU ARE ALLOWING THE DENTAL
NETWORK, L.L.C TO CONTACT EMPLOYERS AND/OR
INSTITITIONS THAT U OBTAINED LICENSURES. PLEASE
SEND A CURRENT COPY OF ALL YOUR DEGREES, LICENCES,
AND CERTIFICATES TO OUR WESITE OR VIA MAIL. NO
PLACEMENT WILL BE MADE WITH OUT THEM.




                                                      Pg. 3 of 5




                                                                   3
                  PERSONAL INFORMATION




NAME__________________________________________________



DOB______________________            SS#___________________



HOME #__________________             CELL#________________



EMAIL___________________________________________________



ADDRESS________________________________________________




**PLEASE Circle WHICH DUTIES YOU CAN PERFORM AND IF
APPLICABLE, WHAT CERTIFICATES OR LICENCES.
PLEASE WRITE DOWN THE LICENCE NUMBER.

x-rays                 impressions         placing restorations

retraction cord        temporaries         lab work   porcelain oven

bleaching trays        zoom prophy         ortho      surgery        perio



computer               insurance           treatment coordination

billing                care credit         infiltration anesthesia

sealants               other____________________________________

Licences/Certificates_____________________________________________
                                                        pg. 4 of 5




                                                                         4
                        WORK HISTORY




DENTIST NAME:
_____________________________________________________________________

ADDRESS:
_____________________________________________________________________

PHONE:
_____________________________________________________________________

SALARY:
_____________________________________________________________________

FROM_____________ TO_______________

REASON FOR LEAVING:
_____________________________________________________________________



DENTIST NAME:
_____________________________________________________________________

ADDRESS:
_____________________________________________________________________

PHONE:
_____________________________________________________________________

SALARY:
_____________________________________________________________________

FROM_____________ TO_______________

REASON FOR LEAVING:
_____________________________________________________________________
ATTACH ANOTHER PG IF NESSASSARY.                            Pg. 5 of 5




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