Massage Therapist Application - Independent Contractor

Massage Therapist Application - Independent Contractor

Please complete the form below to apply for a position with us.
Two-Step Application Process

Thank you for your interest in joining Healing Hands of Estacio! Please note that this application requires the completion of two steps:
1. Complete this application form by filling out all the requested information below.
2. Complete the accompanying questionnaire by accessing the link provided at the end of this form.
  Both steps must be completed to be considered for employment or an independent contractor position. Incomplete applications or failure to submit the questionnaire will result in disqualification from the application process.
We appreciate your attention to detail and look forward to reviewing your submission!
Today's Date*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Are you eligible to work in the United States?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If yes - please explain:
Emergency Contact Information:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The best contact number*
Please enter a valid phone number.Format: (000) 000-0000.
Employment Information:
Date available to start work?*

MonthDayYear
Date
List your hours of availability below (business hours are Mon and Thurs from 10am to 8pm; Tues, Wed and Fri from 10am to 6pm and Sat from 10am to 3pm; Sundays - closed unless an event is planned) If not available then state N/A
Monday*
Tuesday*
Wednesday*
Thursday*
Friday*
Sat*
Would you be willing to work on certain weekend days for events if given prior notice?*

YesNo
Are you currently a licensed massage therapist in the state of Massachusetts? (photo copy required to start):*

YesNo
If not licensed - when do you expect to be licensed? (if not applicable state N/A in the field)*
Massage License Informatation (if no license has yet been obtained - state N/A in both the fields below)*

License NumberExpiration Date
Do you currently have your own personal liability insurance?*

Yes I haveNo I do not
Liability Insurance Provider Information (if no liability insurance has yet been obtained - state N/A in the field(s )below)*
Liability Insurance Provider Name
Liability Insurance Policy Information (if no liability insurance has yet been obtained - state N/A in both the fields below) (photo copy required to start)*

Liability Insurance Policy NumberExpiration Date
If not licensed - when do you expect to be licensed? (if not applicable state N/A in the field)*
Experience and Skill:
How many years of experience do you have in massage therapy?*

Recently Graduated0-1 Year1-3 Years3-5 Years5+ Years
Please indicate all the modalities that you have been properly trained in and are comfortable doing:*

Swedish MassageHybrid Massage (half light/half deep pressure)Deep Tissue MassageHot Stone MassagePrenatal MassageReflexologySports MassageShiatsu Massage
If you require additional time and/or training in any of the above, or any other massage modalities, please indicate *
If you are trained/certified in any other massage modality not listed above, please indicate:
List all other areas of expertise or applicable certifications:
Education:
Name of the Massage/Technical/Vocational School that you attended:*
How many hours of massage training have you had? *
Where did you receive your training? *
How long have you been participating massage?*
Have you had specific training in chair massage?*
Certifications such as CPR Training; Special Training; Seminars; Workshops; Etc.:*
Professional Associations/ Technical Affiliations, if any:
Do you speak any other language other than English?*

Yes I doNo I do not
If yes, please list:
Do you have any other skills that you would like to list here?
Do you have any special interests that you would like to list here?
Employment History:

Please list all jobs, military service and/or self-employment beginning with most present:
Company Name:*
Company Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Employment*

FromTo
Your position while employed in this company?*
Please list all responsibilities/duties you had while employed in this company? *
Name of your supervisor:*

First NameLast Name
Reason for leaving*
Company Name:
Company Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Employment

FromTo
Your position while employed in this company?
Please list all responsibilities/duties you had while employed in this company?
Name of your supervisor:

First NameLast Name
Reason for leaving
Company Name:
Company Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Employment

FromTo
Your position while employed in this company?
Please list all responsibilities/duties you had while employed in this company?
Name of your supervisor:

First NameLast Name
Reason for leaving
References:

List below three persons not related or residing with you who are willing to provide professional references:
Reference One:*

First NameLast Name
The best contact number*
Please enter a valid phone number.Format: (000) 000-0000.
Number of years acquainted.*
Reference Two:*

First NameLast Name
The best contact number*
Please enter a valid phone number.Format: (000) 000-0000.
Number of years acquainted.*
Reference Three:*

First NameLast Name
The best contact number*
Please enter a valid phone number.Format: (000) 000-0000.
Number of years acquainted.*
Additional Information/Comments:
Are you able to perform the essential functions of the position for which you are applying, either with or without reasonable accommodations?*

YesNo
If necessary, please describe reasonable accommodations necessary:
Upload your resume:*

Cancelof
Upload a sample of your work*

Cancelof
References:
I certify that the information in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of independent contractor agreement at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Signature*
Today's Date*

MonthDayYear
Date
Step 2: Complete the Attached Questionnaire

The second part of this application requires you to complete the attached questionnaire.

Please click on the link below to open the questionnaire in a new tab before submitting this application.

https://form.jotform.com/242346380481052

⚠️ Important: Failing to open the questionnaire in a new tab before submitting this application may result in the application not being properly submitted.

Both this application form and the questionnaire must be completed to proceed in the hiring process.
Should be Empty:

Massage Therapist Application - Independent Contractor

Emergency Contact Information:

Employment Information:

List your hours of availability below (business hours are Mon and Thurs from 10am to 8pm; Tues, Wed and Fri from 10am to 6pm and Sat from 10am to 3pm; Sundays - closed unless an event is planned) If not available then state N/A

Experience and Skill:

Education:

Employment History:

References:

References: