"Receptionist Employment Form"
APPLICATION FORM FOR THE POST OF: RECEPTIONIST Please type or complete in black / blue ink GENERAL INFORMATION Name Address Telephone number (Daytime) (Evening) E-mail Date of birth Do you need a work permit? YES/NO Where did you hear about this vacancy? EDUCATION HISTORY (SINCE AGE 11) Name of School/College Qualifications Gained Dates 2 COURSES ATTENDED – Dental and Non-Dental (for example CPR, Practice Management, Dental Receptionist Programme) Name of course Dates MEMBERSHIP OF PROFESSIONAL ORGANISATIONS Name of organisation Dates 3 EMPLOYMENT HISTORY (Most recent first) Dates Employer’s name and address Post held and main duties Reason for leaving 4 FURTHER INFORMATION Please use this space to tell us why you are applying for this post and the skills and experience you will bring to it. 5 REFERENCES Please give the names and addresses of two people we may approach for a reference. One of these referees must be your most recent employer: Name: Name: Address: Address: Tel: Tel: Position: Position: I am willing / I am not willing for my referee to be contacted prior to the I am willing / I am not willing for my referee to be contacted prior to the interview. interview. PLEASE RETURN THIS FORM TO: The Practice Manager, Beech House Dental Practice, 16 College Road, Eastbourne, E. Sussex, BN21 4HZ CLOSING DATE: Friday 4th March 2011 6