To Register Please fill out the below form. All information entered is strictly confidential. Your online profile will be activated once your registration is reviewed. Please enter a username. Account InfoUsername *E-mail *Password *Password must be at least 7 characters long. To make it stronger, use upper and lower case letters, numbers and symbols.Confirm Password *Type your password again. Strength IndicatorFirst Name *Last Name *Address *City *Zipcode *Home PhoneCell Phone *It is okay to send text messages re: placements? *YesNoI am a: * Dentist Hygienist Assistant Front Desk PersonnelI am looking for: *TemporaryPermanentAssociateshipPlease check all that apply.Years of experience * Student Recent Graduate / <1 year 1-2 years 2-5 years 5+ years 10+ yearsDental experience *General DentistryPediatricsOrthodonticsEndodonticsPeriodonticsOral SurgeryProsthodonticsCheck all that apply.Dental software experience *X-Ray software experience *For Dentists: Current AZ Dental License?YesNoDental License #:Anticipated Licensure Date:For Hygienists: Current AZ Hygiene License? Yes NoAZ Hygiene License #:Anticipated Licensure Date:AZ Anesthesia certified? Yes NoLaser certified? Yes NoCurrent CPR? Yes NoOther certifications/special training?For Assistants: RDA or CDA certified? Yes NoAZ/DANB X-ray certified? Yes NoExpanded Functions certified? Yes NoCoronal Polishing certified? Yes NoCPR certified? Yes NoOther certifications/special training?Upload Resume with References Upload resume as a PDF fileUpload resume as a Word docUpload resume as an image fileOnce your information is reviewed, Dental Temps AZ will contact you to schedule an interview. Robot Detection * Register
