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Your Partner in Supplying Qualified Temporary Dental Staff

Dental Office Registration

Name of Office*

Mailing Address*

Phone Number*

Contact Person*

Email Address*

Notes

Request a Temp

Name of Office*

Phone Number*

Email Address*

RDA or RDH

Dates/Times*

Notes

RDH / RDA Registration

First Name*

Last Name*

Mailing Address*

Cell Phone Number*

Email Address*

RDA or RDH

Permit Number

Notes

Contract and Policies

By submitting this form and using FIRST CHOICE TEMP CONTRACTORS INC. services, the dental office agrees to indemnify and hold FIRST CHOICE TEMP CONTRACTORS INC. and its owners harmless from and against any and all liabilities, damages, losses, actions, or causes of action, costs, and expenses (including attorney’s fees), whether relating to using the services of FIRST CHOICE TEMP CONTRACTORS INC or of any third party, or to personal injury or death, arising out of or in any way contributed to by the acts or failure to act of the dental office, its agents, employees, officers, or FIRST CHOICE TEMP CONTRACTORS INC. supplied subcontractors. 

Rates may vary. Last minute fees may apply (less than a 24-hour notice). All shifts have a three-hour minimum.

Time sheets must be signed by the end of the day. 

Dental office agrees not to contact temp outside of FIRST CHOICE TEMP CONTRACTORS INC. for temporary staffing while temp and dental office are registered with FIRST CHOICE TEMP CONTRACTORS INC. A non-refundable fee of $800 will be charged to the dental office if the dental office hires a temp that is registered with FIRST CHOICE TEMP CONTRACTORS INC. By submitting this form, the dental office understands and agrees to the above. Thank you.

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