9.1. SR 08-21-2017 - Laserfiche WebLink

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5 For applicants that are corporations or other types of organizations. a. The applicant’s name and current address. b. The applicant’s current employer. c. The applicant’s employers for the previous five (5) years, including the employer’s name, address and dates of employment. d. The applicant’s address for the previous five (5) years. e. The applicants’ date of birth, home telephone number, weight, height, color of eyes, and color of hair. f. Whether the applicant has ever been convicted of any felony, crime, or violation of any ordinance other than a minor traffic offense, and, if so, the time, place, and offense which convictions were had. g. Whether the applicant has had an interest in, as an individual or as part of a corporation, partnership, association, enterprise, business or firm, a massage license that was revoked or suspended within the last five (5) years of the date the license application is submitted to the Issuing Authority. (B) Massage Therapist License Application. An application for a massage therapist license shall be made on a form supplied by the Issuing Authority and shall request the following information: 1. The applicant’s name and address. 2. The applicant’s current employer. 3. The applicant’s employers for the previous five (5) years, including the employers’ name, address, and dates of employment. 4. The applicant’s addresses for the previous five (5) years. 5. The applicant’s date of birth, home telephone number, weight, height, color of eyes, and color of hair. 6. Whether the applicant has ever been convicted of any felony, crime, or violation of any ordinance other than a minor traffic offense and, if so, the time, place, and offense for which convictions were had. 7. Whether the applicant has had an interest in, as an individual or as part of a corporation, partnership, association, enterprise, business or firm, a massage license that was revoked or suspended within the last five (5) years of the date the license application is submitted to the Issuing Authority. 8. Whether the applicant is a U.S. Citizen or resident alien or has the legal authority to work in the United States. 9. Whether the applicant has ever used or been known by a name other than the applicant’s name, and if so, the name or names and information concerning dates and places where used. 10. Whether the applicant has met the definition of massage therapist in this Code.