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Personal Information

First name
Last name
First name
Social Security:
Address
Address 2
City
State
Zip
Daytime Phone
Ext
Evening Phone
Other Phone
Email Address

Best Time to Call
Preferred Location?
If maried, spouse's name:
Spouse's Social Security
Birth Date
Will you have any business partners, and if so what are their names? (Please note each partner must complete a seperate application)

Business Experience/Education

Youremployer
Position
Annual Income
Have you ever owned a business?
yesno
Have you ever owned a massage business?
yesno
Level of Education
High SchoolCollegeGraduate School
Address
Immediate supervisor and title

May we contact for reference?
yesnoLater
Summarize nature of work performed and job responsibilities
Reason for leaving
Hourly rate/Salary

Start
Per
Final
Per
Job 2
From

To
Employer

Telephone
Starting Job Title/Final Job title

Address
Immediate supervisor and title

May we contact for reference?
yesnoLater
Summarize nature of work performed and job responsibilities
Reason for leaving
Hourly rate/Salary

Start
Per
Final
Per
Job 3
From

To
Employer

Telephone
Starting Job Title/Final Job title

Address
Immediate supervisor and title

May we contact for reference?
yesnoLater
Summarize nature of work performed and job responsibilities
Reason for leaving
Hourly rate/Salary

Start
Per
Final
Per
Job 4
From

To
Employer

Telephone
Starting Job Title/Final Job title

Address
Immediate supervisor and title

May we contact for reference?
yesnoLater
Summarize nature of work performed and job responsibilities
Reason for leaving
Hourly rate/Salary

Start
Per
Final
Per

Skills and Qualifications

Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job related functions in the position for which you are applying.

References

Job 1
First Name

Last Name

Datetime Phone

Ext

Years Known

Job 2
First Name

Last Name

Datetime Phone

Ext

Years Known

Job 3
First Name

Last Name

Datetime Phone

Ext

Years Known

Educational Background

High School

No of years completed

Did you graduate
yesno
Course of study

Trade School/Technical College


Number of hours completed

Did you graduate
yesno
Do you have your provisional?
yesno
Do you have your license?
yesno
If yes: What is your license #?

College


Number of years completed

Did you graduate
yesno
Major Degree

Course of study

Other


Number of years completed

Did you graduate
yesno
Course of study

How did you hear about MassageLuXe?

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) cancel further consideration of this application, or (2) immediately discharge me from the employers service whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in written and signed by the employers president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

DO NOT SUBMIT THIS FORM UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Name*