Recruitment - IFLOSS - Coalition of Communities Working Together to Improve Oral Health in Illinois

Coalition of Communities
Working Together
to Improve Oral Health in Illinois

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Job Posting Form

Please complete and return to Ifloss Coalition. The information you provide will be used to market your community and practice site; therefore, it is important to be as detailed and thorough as possible.

Ifloss Coalition
1415 E. Jefferson St .
Springfield , IL 62703
Phone (217) 789-2185
Fax (217) 789-2203

Name of Practice Site

Name of Administrative Office (if different)

Address

Administrative Address

City, State, Zip

Contact (person responsible for recruitment)

Administrative Contact

Contact's Title

Phone

Fax

E-mail

Number of dentists at site:

Number of dental assistants:

Number of dental hygienists:

Number of dental operatories:

Practice type:

Private
Non-Profit
Public

Practice description (check all that apply):

Solo
Solo w/Assoc.
Single Specialty Group
Multi Specialty Group

Community Health Center
Rural Health Center
Migrant Health Center

Hospital Based
Community Based

State Institution/Facility
Health Department

Additional practice details:

COMMUNITY INFORMATION :

Community:

Community Population:

County:

County Population:

HPSA:

Yes
No

NHSC site:

Yes
No

DENTAL OPPORTUNTIES:

Please indicate the number of opportunities for each specialty and the proposed hire date:

Specialty	Proposed Hire Date	Full or Part-time	Number Hours/Week
DDS/DMD*
D. Hygienist
D. Assistant
*Specialty or additional specialization required:

ADDITIONAL POSITION DETAILS:

Language skills preferred of applicants?

Yes
No
Which?:

If so, is this a requirement?

Yes
No

Vacation (# of days/year):

Salary Range :

info@ifloss.org

1415 E. Jefferson St., Springfield, IL 62703

Phone (217) 789-2185 • Fax (217) 789-2203