Position Applied for * -Choose- Hair Stylist Esthetician Assistant Receptionist Employment type * -Choose- Part-time Full-Time Date Name First * Last * Middle Present Address Street * City * State * Zip * 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 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 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 Resume: Prove that you are human *: * 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.