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




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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




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EMPLOYMENT HISTORY (Most recent first)

   Dates              Employer’s name and address       Post held and main duties   Reason for leaving




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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.




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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




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