Position Applied for * -Choose- Massage Therapist Physical Therapist Curl Specialist Professional Braider Change Receptionist to Concierge Esthetician Receptionist Shampoo Assistant Internship Hair Stylist Bridal Hair Specialist Make Up Artist Employment type * -Choose- Part-time Full-Time Date Name First * Last * Middle Present Address Street * City * State * Zip * How long at Present Address? Years * Years 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 Months * Months Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Previous Address Street City State Zip How long at Previous Address? Years Months Telephone No. * Email Address: * Are you a licensed Cosmetologist: -Choose- Yes No State License No (please include state): Note: Answering "Yes" to the following four questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic citations and arrests or convictions which have been sealed or expunged in answering this question.) Have you ever worked for this company before? -Choose- Yes No If Yes please give dates and position Have you ever pled guilty, or no contest to, or been convicted of a felony? -Choose- Yes No If Yes please give dates and details Have you ever pled guilty, or no contest to, or been convicted of a misdemeanor resulting in imprisonment within the last seven years? -Choose- Yes No If Yes please give dates and details Have you been arrested for any matters for which you are out on bail or on your own recognizance pending trial? -Choose- Yes No If Yes please give dates and details Record of Previous Employment Please list the name of your present or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references. Present or Last Employer Address * City, State, Zip * Telephone * Employed(From/To) Pay(Start/Finish) Title or Position Name and Title of Supervisor Exact Reason for Leaving Present or Last Employer Address City, State, Zip Telephone Employed(From/To) Pay (Start/Finish) Title or Position Name and Title of Supervisor Exact Reason for Leaving Present or Last Employer Address City, State, Zip Telephone Employed(From/To) Pay (Start/Finish) Title or Position Name and Title of Supervisor Exact Reason for Leaving Have you ever been terminated or asked to resign from any job? -Choose- Yes No If Yes please explain the circumstances Please explain fully any gaps in your employment history: May we contact your current employer? -Choose- Yes No If No, please explain: * Please indicate any qualifications or special skills. Have you ever used another name? Is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work and educational record? If yes, please explain. Education School Name: Years Completed Diploma/Degree High School * College/Univ.* Grad/Professional Industry Academy/Beauty School Other: Other: Personal References Please list persons who know you well - exclude previous employers or relatives Name Occupation Address (Street, City, State) Telephone Number Number of Years Known * I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE. This application will be considered active for a maximum of thirty (30) days. If you wish to be considered for employment after that time you must reapply.