Grand Canyon Chapter
American Red Cross
Dental Assistant Training Program
APPLICATION
*****Applications must be type written and signed*****
Due: December 14, 2012 (NLT 1630)
Name:
(Last Name)
(First Name)
(M.I.)
(Preferred Name)
Phone:
(Daytime)
(Evening)
(Cellular)
Email Address:
Mailing Address:
Scheduled PCS Date:
Emergency Contact:
(Name)
(Relationship)
(Daytime Contact Number)
Date of ETS/DEROS:
(Double click to check box)
Do you possess a high school diploma or GED?
Yes
No
Are you an U.S. Armed Forces ID Card holder?
Yes
No
PLEASE ANSWER THE FOLLOWING QUESTIONS:
(All answers must be type written. Answers may be continued on a separate paper. Please attach to application. Please
answer all questions in complete sentences.)
1. Describe your experience in the dental or health care field?
***** Completion of the program does not guarantee employment. *****
2. Please provide a detailed explanation in your own words (layman terms) of the job functions of a dental assistant?
3. How do you plan to apply the knowledge gained through this training program?
4. The American Red Cross and the dental clinics are seeking candidates with a commitment to complete the
program and who will treat the training program as a regular job. What factors do you feel will contribute to your
success and completion of this volunteer training program?
5. Please explain what the completion of this training program does and does not guarantee.
6. Please describe a specific instance when you set a goal for yourself and how you went about achieving that goal.
7. Please list three characteristics about yourself and explain how each characteristic could enhance or detract from
your learning experience in this training program.
***** Completion of the program does not guarantee employment. *****
8. Please describe your educational background (i.e. What is your highest level of education? If you have a major,
please let us know). How have you applied your educational background to your paid or volunteer job
experiences?
9. Describe your volunteer experience in this community and/or past volunteer experience.
10. Please describe any allergies or sensitivities to latex or cleaning products that you may possess.
11. Some procedures in the dental profession create small amounts of blood. Please describe in detail how the sight
or smell of blood affects you.
12. Some procedures in the dental profession may include you being around individuals with body odor, halitosis or
chemical smells. Please describe in detail how strong unpleasant odors affect you.
***** Completion of the program does not guarantee employment. *****
13. Please provide a detailed explanation of your comfort level of working with children ranging in age from 1 to 10
years and your experience with this age group.
14. Please describe how you will make an anxious patient more at ease when obtaining dental examinations or dental
work.
15. How many hours in a 40-hour work week will you be able to volunteer?
16. What motivates you to do your best work?
17. How do you usually learn something new (watching, reading or performing)? Please explain your current study
habits.
18. Tell us about an occasion when you had to communicate complex information. Why did you have to do this and
how did you go about it? Did you achieve your desired result?
19. Looking back, what would you do differently in your life?
20. In your own words, describe teamwork and how you apply the concept.
***** Completion of the program does not guarantee employment. *****
21. How do you plan to balance the work load required by this program with the other activities/responsibilities in
your life?
22. Describe a personal achievement of which you are particularly proud? What is it? Why is it significant?
23. What issues do you foresee that may prohibit you from completing this training course?
24. Please provide an explanation about a challenging situation you have faced. What was the situation and how did
you cope with it?
25. The testing day will most likely be a long day. Describe how you will handle such a long day, with periods of
inactivity combined with high stress testing situations?
26. Is there any additional information you would like us to consider when reviewing your application? If yes,
please explain.
***** Completion of the program does not guarantee employment. *****
27. Please provide in your own words a 250 word (minimum) essay stating how you would encourage others to
practice good oral hygiene, and what actions individuals may take to create their own oral hygiene regime.
28. Please provide in your own words a 250 word (minimum) essay where you see your career in the next five years.
Please include any career progressions, degrees or certifications, and personal goals.
*OPTIONAL:
Feel free to include any letters of recommendation that you would like us to consider along
with your application.
I hereby attest that the aforementioned information is correct and reflects my work, educational and life experience. I
affirm that I completed this application to the best of my knowledge.
Applicant’s Signature
Date
Training program information:
 A minimum of 62 hours of classroom training in the first three weeks of the program.
 An additional 1000 volunteer hours of clinical experience to be completed within seven months of the program
start date.
 A minimum of 15 hours each week must be spent volunteering in the Dental Clinic.
 All program guidelines must be strictly adhered to for successful completion of the course.
***** Completion of the program does not guarantee employment. *****