Massage Therapist Job Application
Applicant Contact Information
Full Name
*
First Name
Middle Name
Last Name
Preferred Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Street
*
City / State / Zip
*
Licensing Information
Massage Therapy License Number
*
State Issued
*
Expiration Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
License Current and in Good Standing Certification
*
I certify that my massage therapy license is current and in good standing.
Training, Work Authorization, and Availability
Additional Training / Certifications
Prenatal
Hot Stones
Neuromuscular Therapy
Other Training / Certifications
Legally Authorized to Work in the U.S.
*
Yes
No
Desired Start Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Availability
Weekdays
Evenings
Weekends
Preferred Number of Hours per Week
Years of Massage Therapy Experience
Employment and Experience
Previous Employer
*
Location
*
Dates of Employment
*
Briefly describe your massage style and specialties
*
What levels of pressure are you comfortable applying?
*
Comfortable writing SOAP or treatment notes after each session
*
Yes
No
Professional References and Signature
Professional Reference #1 Name
*
First Name
Middle Name
Last Name
Professional Reference #1 Relationship
*
Professional Reference #1 Phone / Email
*
Professional Reference #2 Name
*
First Name
Middle Name
Last Name
Professional Reference #2 Relationship
*
Professional Reference #2 Phone / Email
*
Applicant Signature
*
Application Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Application
Submit Application
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