Internal Transfer Request Form

Internal Transfer Request Form
Please utilize this form if you are interested in transferring to another office location. For detailed office locations please visit: https://www.brushandfloss.com/locations/

Please make sure you have communicated to your office manager to transfer to another office prior to completing this form. Once form is completed it will be submitted to Regional Manager and Human Resources. A team member will reach out to you if there is a business need/opening in your preferred location. Please keep in mind should your transfer request be approved it may take sometime to ensure we've identified your replacement is ready to go and trained!

For more questions regarding internal transfer requests please contact your office manager.
Employee Name*

First NameLast Name
Current Position (ex: Dental Assistant, etc.)*
Current Office Location*
Current Office Manager*
Hire Date within company:

MonthDayYear
Date
Position interested in?*
If this is a clinical position have you consulted with the doctor about this change?*
Please list the office locations you are interested in:*
Current Work Schedule (ex: M-F) *
Confirm Employee work hours (ex: 8-4 PM, no lunch), etc.*
Anticipated Transfer Date (if applicable)

MonthDayYear
Have you discussed the internal transfer with your Office Manager?*
It is important prior to submitting this form to let your Office Manager know.
Why are you interested in transferring?*
Additional Comments*
Employee signature:

Clear
Should be Empty: