Get Dental Assistant Application

This guide provides a comprehensive overview of how to successfully complete the Dental Assistant Application online. By following the steps outlined below, you can ensure that your application is filled out accurately and completely.

Follow the steps to complete your application with ease.

1. Click ‘Get Form’ button to access the application form and open it in your preferred online editor.
2. Begin by entering your full name in the designated field. If applicable, include your maiden name as well.
3. Provide your residential address, including the postal code. Additionally, you will need to enter your office address (if applicable), including the postal code and the name of the supervising doctor.
4. Fill in your contact information by entering your residence and office telephone numbers.
5. Enter your date of birth in the format of month/day/year, and specify your place of birth.
6. In the relevant section, state your current status as a certified Level II dental assistant along with details of your accreditation, including the institution attended, location, and dates of attendance.
7. If applicable, provide information about other dental assisting programs you have attended, including the institution, city, and dates of attendance.
8. Answer whether you are licensed to practice dental assisting in any other location. If yes, specify where and provide a letter of good standing from the provincial licensing board.
9. Document all addresses of locations where you have practiced since graduation, including the duration at each location.
10. If any of your licenses have been suspended or revoked, provide a detailed explanation in the space provided.
11. Review and agree to the application declaration, affirming that there are no known reasons why you should not be granted a license.
12. Sign the application form as the applicant, and ensure it includes a solemn declaration affirming the truthfulness of your submitted information.
13. Lastly, have a commissioner of oaths or notary public certify your photograph and confirm your identity, signing and dating the form as required.
14. After completing all sections, save your changes. You may download, print, or share the completed form as necessary.

Complete your Dental Assistant Application online today and take the next step in your career.