Massage Therapist Job Application

A Touch of Serenity

Massage Therapist 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
POSITION AVAILABILITY
When would you be available to start? *

Month Day Year
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
EDUCATION

Please select the number of years completed for the following educational institutions
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
EMPLOYMENT INFORMATION

please list the information from your most recent or present employer
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
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 *

Swedish Deep Tissue Prenatal Hot Stone Body Scrubs Cupping Thai Massage Shiatsu Lymphatic Drainage Lomi Lomi
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 *

Cancel of
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.
Should be Empty:

A Touch of Serenity

POSITION AVAILABILITY

EDUCATION

EMPLOYMENT INFORMATION

REFERENCES

MASSAGE THERAPY EXPERIENCE