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ATTACH RESUME - CLICK HERE
SEE ATTACHED RESUME
Personal Information
Today's Date
First Name
MI
Last Name
DOB
Address
City
State
Zip
Home Phone
Cell Phone
Email
Licenses
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Education
High School Name/Location
College Name/Location
Technical School Names/Locations
Certifications
Other Credentials (Affiliations, Awards, etc.)
SEE ATTACHED RESUME
Work History
Begin with your most recent employer and account for your last three jobs or the last seven years, whichever is shorter.
If you worked under a different name, please indicate:
Job 1
Employer Name
Address
State
Zip
Phone
Dates of Employment - From/To
Position
Full Time
Part Time
Duties
Name of Supervisor
Starting Pay $
Present/Final $
Job 2
Employer Name
Address
State
Zip
Phone
Dates of Employment - From/To
Position
Full Time
Part Time
Duties
Name of Supervisor
Starting Pay $
Present/Final $
Job 3
Employer Name
Address
State
Zip
Phone
Dates of Employment - From/To
Position
Full Time
Part Time
Duties
Name of Supervisor
Starting Pay $
Present/Final $
SEE ATTACHED RESUME
References
Please provide Three References.
Note: At least one professional reference.
Professional Reference #1
Affiliation
Name
Phone
Misc. Reference #2
Affiliation
Name
Phone
Misc. Reference #3
Affiliation
Name
Phone
SEE ATTACHED RESUME
Equipment
Do you have a cellular phone?
Yes
No
Number
Do you have a working computer?
Yes
No
Do you have internet access?
Yes
No
Do you have a massage table?
Yes
No
Adjustable cradle?
Yes
No
Width?
Weight?
Foam
Double
Triple
Do you have a massage chair?
Yes
No
Do you have a current Driver's License?
Yes
No
Driver's License
#
Have you ever been denied a driver's license, or had your license revoked or suspended?
Yes
No
If yes, please explain:
Do you have a working car?
Yes
No
Make
Model
Year
License Plate No.
Do you have auto insurance?
Yes
No
Carrier
Coverage
SEE ATTACHED RESUME
Availability
Date available to begin contracting (Month/Day/Year)
Hours Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
SEE ATTACHED RESUME
Miscellaneous
Are you able to perform all essential functions of the job for which you are applying
without accomodation?
Yes
No
If hired as a Body Specialist, do you agree to follow safety rules and professional codes of ethics to perform all duties in a professional and therapeutic manner?
Yes
No
Comments
Applicant Signature
Please read the following paragraphs very carefully before signing this application.
I certify that to the best of my knowledge and belief, the statements made by me in this application are correct and complete without omission of any kind. I understand that any false information I give when applying, whether in this application or otherwise, is cause for termination, regardless of when discovered. You are hereby authorized to investigate all the statements made in this application, except for any information about disability and medical conditions or treatment, which is prohibited by the Americans With Disabilities Act.
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