Monroe
C ounty E nterprises
EMPLOYMENT APPLICATION
Provide all information requested by printing in ink or keying. Use the tab key to move through the document.
GENERAL INFORMATION
Name (Last) (First) (Middle Home Telephone
Poland Molly Initial) (478) 719 - 3239
Address (Mailing Address) (City) (Stat (Zip)
D. Cell Phone
572 King Road Forsyth e) 31029 (478) 283 - 6416
E-mail Address GA
s.molly.poland@mcschools.org
POSITION
Position or Type of Employment Desired Will Accept:
Dental Hygienist Part-Time Full-Time
Have you ever been employed at the Monroe County Enterprises before?
Yes No
Date Available: 01/27/2026
Are you able to perform the essential functions of the job you are applying
for, with or without reasonable accommodation? Yes No
Salary Desired
$5,397.92/Monthy
EDUCATION AND TRAINING
Beginning
School or
Name and Address of School Major/Study & Ending Degree
Institution
Year
High School Mary Persons High School Therapeutic Services - 2017-2021 Diploma
Dental Science
College Name Augusta State University Dental Hygienist 2021-2025 BA
College Address 1120 15th St, Augusta, GA 30912
College City & Augusta Georgia
State
Special Abilities and Skills (3 tasks from CIS) Professional Certificates or Licenses Held (Yes
Clean teeth and examine oral areas, head, or No)
and neck for signs of oral diseases. yes
May educate patients on oral hygiene.
Take X-Rays, apply, fluid ,or sealants.
Extracurricular Activities (at least 2 areas of Present Community and Professional
interest/hobby) Affiliations (at least 2)
Golf Youth
Piano Charites
Poet
Languages Read, Written or Spoken Fluently Other Than English
N/A
REFERENCES
List below names and addresses of persons who are qualified to answer questions concerning your fitness for the
position(s) you seek other than those listed in your credential file. (3 classmates from THIS class. Get a sheet of
paper and Go to the L Drive folder REFERENCES jot down the information and come back to this
document and type it in.)
AN EQUAL OPPORTUNITY EMPLOYER
Name Position Address Telephone
Taylor Short Registered 104 Courtyard Place, Forsyth, GA 31029 478.972.3916
Nurse
Nadia Davis Registered 500 Stroud Street,Forsyth,GA31029 478.974.8460
Nurse
Newberry Carson Forester 21 Heritage LN, Macon GA, 31210 478.284.8953
WORK EXPERIENCEMost recent first, include voluntary work and military experience
Employer Top-Notch, Inc. Telephone Number (478) 994 - 6186 From (Month/Year)
Address 1120 15th St, Augusta, GA 30912 October/2023
Job Title Physical Therapist Aide Number Employees Supervised 2 To (Month/Year)
Specific Duties (Maximum 350 characters) March/2025
lifting heavy objects X assembling products X operating heavy machinery X Hours Per Week
budget reports 15-20
X taking pictures filing data entry faxing counseling Last Salary
washing/cleaning vehicles $9/hourly
X typing copying X recording X cleaning handling various reports
running errands
X assisting the director/boss repairing equipment inventory control
customer service Supervisor
S. Dorsey
driving/delivering ordering/buying supplies cutting/washing hair X
answering phone
supervising 1 / 2 stocking X organizing
Reason For Leaving Graduated College May We Contact This Employer? Yes
No
I certify the information contained in this application is true, correct, and complete. I understand that, if
employed, false statements reported on this application may be considered sufficient cause for dismissal.
You will enter an electronic signature. Click in the gray box beside Signature of Applicant select any
script or cursive style font type your first and last name (capitalize the first letter of each).
Signature of Applicant: Molly D. Poland Date: 01/31/2026
AN EQUAL OPPORTUNITY EMPLOYER
