Fillable EMPLOYEE DENTAL WORK VERIFICATION Credit toward admission into (Mohave Community College)

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EMPLOYEE DENTAL WORK VERIFICATION Credit toward admission into (Mohave Community College)

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The EMPLOYEE DENTAL WORK VERIFICATION Credit toward admission into (Mohave Community College) form is 1 page long and contains:

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  • 11 other fields

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File type: PDF

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3400 Highway 95, Bullhead City, AZ 86442 ◊ 928.704.4178 ◊ 928.704.7790 Fax
EMPLOYEE DENTAL WORK VERIFICATION
Credit toward admission into the Dental Hygiene Program is given for volunteer or paid work experience in a
dental office. One (1) point will be awarded for each 500 hours of experience, up to 2500 hours, for a maximum
award of 5 points.
Employee: __________________________________________ Start date: __________________________
Position: ___________________________________________ End date: __________________________
Total hours worked: _________________
(Please do not enter hours per week.)
Specific duties:
Would you hire this person again? YES NO MAYBE
Employer: ______________________________________
Address: ______________________________________ ___________________________________
Employer’s signature
______________________________________
Phone #: ______________________________________ ___________________________________
Date
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EMPLOYEE DENTAL WORK VERIFICATION Credit toward admission into (Mohave Community College)

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Completed 2 September 2020

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