Simply Styling School of Cosmetology

1

Name

First Name

Last Name

2

Date

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SSN#:* This field is required.

4

Cell Number

Area Code

Phone Number

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Work Number:

6

Email:

example@example.com

7

Address

Mailing Address

City/State/Zip

Country

8

Marital Status:

9

Sex:Your choice

10

U.S. Citizen

YESNO

11

Do you have a: High School DiplomaIf so, please provide a copy of document.

YESNO

12

Do you have a GED?If so, please provide a copy of document.

YESNO

13

Please list all colleges and post-secondary schools attended:

14

School:

15

Date Completed:

Date

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Degree

17

School

18

Date Completed

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Degree:

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Course of study:

22

Only fill out if you are applying for a

(Cosmetology, Barbering or Nail Tech)

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Apprentice Name:

First Name

Last Name

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License Number:

25

Apprenticeship start date:

Date

26

Apprenticeship end date

Date

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Name of Location:

28

Phone #:

29

Address:

30

Name:

31

Is Instructor Cosmetologist or Barber

Instructor Cosmetologist or Barber

Licensed Cosmetologist

Licensed Barber

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I hereby affirm that the answers o the above questions are to the best of my knowledge,* This field is required.

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Apprentice Signature:

34

Date:

Date

35

Phone Number

Area Code

Phone Number