Apply for Dental Assistant - Potomac Management Solutions

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Apply for Dental Assistant

Please create an applicant profile by providing information as requested below and attach your resume for consideration.

NOTICE: Submission of your resume does "NOT" constitute completion of an employment application. If selected to participate in an interview and proceed with processing, you will be contacted by a member of our staffing team and asked to complete an application at that time.

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Summary
Title:	Dental Assistant
ID:	2785 KITTRELL JCC
City:	Kittrell
State:	North Carolina

Resume
* Resume:	Supported formats: Word, PDF, RTF, Text, and HTML.

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Contact Information
* First Name:
* Last Name:
Address:
City:
State:
Zip:
* Phone:
* Email:
Application Information
Current Clearance Held:
Desired Salary:
How did you hear of us?:

Voluntary Self-Identification of Disability CC-305

Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 01/31/2020

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.ⁱ To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

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ⁱ Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Applicant Commitment

* I hereby grant permission to Potomac Management Solutions (PMS) to submit my name and resume as a candidate for the position noted above. I further confirm my interest in employment with PMS, should I be selected for this position, meet the necessary clearance requirements and conditions of employment.

	Yes
	No

* Signature:

* Date

Experience Working with Adolecents

* Do you have 1 year or more of experience working with Adolescents?

	Yes
	No

* How many years of experience working with adolescents to you have?

	Less than 1 year
	1-5 years
	5+ years
	I have no experience working with adolescents.

* Please sign Statement of Experience:

Dental Assistant - Kittrell JCC

* Do you have Dental Assistant Experience ?

	Yes
	No

* Do you have a Dental Assistant Certificate?

	Yes
	No

* Do you have an Xray Tech Cert?

	Yes
	No

Authorization Release 2

DISCLOSURE AND RELEASE

Potomac Management Solutions, LLC may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources. These reports may be obtained at any time after receipt of your authorization and, if you are hired, throughout your employment. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your criminal history, education and/or employment history conducted by Potomac Management Solutions or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing Employer to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if you are hired, throughout the course of your employment is limited to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

New York applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by Employer.

ACKNOWLEDGMENT AND AUTHORIZATION

I acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand the Disclosure and Release, and the Acknowledgement and Authorization. I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" at any time after receipt of this authorization and, if I am hired, throughout my employment. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Potomac Management Solutions, LLC or another outside organization acting on behalf of Employer, and/or Employer itself. By my acceptance below, I certify that this electronic signature and facsimile ("fax") or photographic copy of this authorization and acceptance of terms via my electronic signature shall be as valid as my original handwritten signature.

Minnesota and Oklahoma applicants or employees only: Feel free to advise if you would like to receive a copy of a consumer report if one is obtained by the Company.

California applicants or employees only: By providing your electronic signature below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Feel free to advise if you would like to receive a copy of an investigative consumer report or consumer credit report if one is obtained by the Company at no charge whenever you have a right to receive such a copy under California law.

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Consumer Disclosure:
Conducting business electronically, receiving electronic notices and disclosures, and signing documents electronically

Please read the following information carefully.
By proceeding forward and signing this document you are agreeing that you have reviewed the following consumer disclosure information and consent to transact business using electronic communications, to receive notices, disclosures, and to utilize electronic signatures in lieu of using paper documents provided over the course of your relationship with this company for which you have submitted an application for employment. This electronic signature service is provided on behalf of the company, whom is sending to you electronic documents, notices, disclosures or requesting electronic signatures. You are not required to receive notices and disclosures or sign documents electronically. If you prefer not to do so, you may request to receive paper copies and withdraw your consent at any time by contacting the company by telephone, postal mail, or by sending an email. Company contact information is listed below.

13000 Harbor Center Drive #302
Woodbridge, Virginia 22192

By my acceptance below, I certify that this electronic signature and facsimile ("fax") or photographic copy of this authorization and acceptance of terms shall be as valid as my original handwritten signature.

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MSEP Questionnaire

Please complete.

Military spouse data is 100% anonymous and collected in support of outreach and hiring military spouses for our positions nationwide. Potomac Management Solutions, LLC (PMS) values the military spouse community and all that they do in support of our troops. PMS is a proud member of the Military Spouse Employment Partnership.

* Are you an Active Duty, National Guard or Reserve Military Spouse?

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