Massage Therapist Job Application

Full Name (if no middle name, type none) *

First Name Middle Name Last Name

Current Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Email Address *

example@example.com

Birth Date *

Month Day Year

Massage License Number *

Emergency Contact -- Name, phone number, and relationship *

In the last 10 years have you been convicted of a crime other than minor traffic offenses? *

Yes No

Have you ever been involved with any incident that compromised or resulted in the suspension of your massage therapy license *

Yes No

If you answered yes to either question above, please explain below

Are you legally eligible for employment in the United States *

Yes No

When would you be available to start? *

Date

What days of the week are you available? Select all that apply *

Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Sundays

What times of day are you typically available? Select all that apply *

Mornings Afternoons Evenings

High School

1 year 2 years 3 years 4 years GED

College

1 year 2 years 3 years 4 years

Graduate Level

1 year 2 years 3 years 4 years

Please list any other vocational or training degrees/certificates you have completed. Be sure to include the school name, city/state, date of completion, type of certificate/license earned, certificate/license number, license expiration date

May we contact your present employer?

Yes No

Employer Name

Employer Telephone

Please enter a valid phone number.

Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Your position title

Dates of employment

Salary

Supervisor name

Reason for leaving

Reference Names -- Relationships -- Phone Numbers -- Years Known *

Please select all modalities that you have experience in providing *

Please select all session lengths that you provide *

Thirty Minute Sixty Minute Ninety Minute Two Hour

Please list any additional modalities you provide that we have not listed

Please upload your resume

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By selecting submit below, I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize A Touch of Serenity to verify the accuracy and to obtain reference information on my work performance. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules, and regulations of the company.

A Touch of Serenity

POSITION AVAILABILITY

EDUCATION

EMPLOYMENT INFORMATION

REFERENCES

MASSAGE THERAPY EXPERIENCE