National Massage Network
Employment Application Form

(All information is considered confidential)

Contact Information
Your Name:       
Street Address:   
City:       State:      Zipcode:   
Home Phone (xxx-xxx-xxxx):       Mobile Phone (xxx-xxx-xxxx):      
Date of Birth (mm/dd/yyyy):      Nearest Major City:   

Certification / License Information

Massage License (If State Required):        License City or State:   
Massage License #:          License Expiration (mm/yyyy):        
Liability Insurance?:  
Insurance Provider:     Policy #:     Exp. Date (mm/yyyy):  

General Information

How many hours of massage training have you had?  
Have you had specific training in chair massage?  
How many years have you been practicing massage?  
How many years have you been practicing chair massage?  
Do you own a professional massage chair?  
Which Brand and Model?  

References  (Please list 2 professional references)

Reference #1 - Name:   
Phone Number (xxx-xxx-xxxx):       Relationship:   
Reference #2 - Name:   
Phone Number (xxx-xxx-xxxx):       Relationship:   
                          Comments or additional information we should know: 
                    
Image Validation:
Please enter the characters
in the image to the right.
All letters are lowercase. 		Image Validation
Characters:
                                                
© Kneaded Energy. All rights reserved.