Massage Therapist Job Application

A Touch of Serenity -- Massage Therapist Application

6218 B Old Franconia Rd. Alexandria Virginia 22310
Full Name (if no middle name, type none)*

First NameMiddle NameLast Name
Current Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email Address*
example@example.com
Birth Date*

MonthDayYear
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?*

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

YesNo
If you answered yes to either question above, please explain below
Are you legally eligible for employment in the United States*

YesNo
POSITION AVAILABILITY
When would you be available to start?*

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

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

MorningsAfternoonsEvenings
EDUCATION

Please select the number of years completed for the following educational institutions
High School

1 year2 years3 years4 yearsGED
College

1 year2 years3 years4 years
Graduate Level

1 year2 years3 years4 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
EMPLOYMENT INFORMATION

please list the information from your most recent or present employer
May we contact your present employer?*

YesNo
Present or Most Recent Employer Name*
Employer Telephone
Please enter a valid phone number.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your position title*
Dates of employment*
Hourly Salary*
Supervisor name*
Reason for leaving*
REFERENCES

Please list a total of 3 references. 1 personal (non-family) and 2 business references
Reference Names -- Relationships -- Phone Numbers -- Years Known*
MASSAGE THERAPY EXPERIENCE
Please select all modalities that you have experience in providing*

SwedishDeep TissuePrenatalHot StoneBody ScrubsCuppingThai MassageShiatsuLymphatic DrainageLomi LomiMyofascial Release
Please select all session lengths that you provide*

Thirty MinuteSixty MinuteNinety MinuteTwo Hour
Please list any additional modalities you provide that we have not listed
Please upload your resume if your resume has not already been provided

Cancelof
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.
Please verify that you are human*
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A Touch of Serenity -- Massage Therapist Application

POSITION AVAILABILITY

EDUCATION

EMPLOYMENT INFORMATION

REFERENCES

MASSAGE THERAPY EXPERIENCE