Application Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Birthdate * MM DD YYYY Education: * Some High School High School Graduate Some College College Graduate Availability * Check all days available Monday Tuesday Wednesday Thursday Friday Saturday Employment History 1 * Please list your previous employment history starting with most recent. Position * Start Date * MM DD YYYY End Date MM DD YYYY Reason for Leaving * Employment History 2 Employer Company Name Position Start Date MM DD YYYY End Date MM DD YYYY Reason for Leaving Reference 1 * Relationship Reference 1 Phone (###) ### #### Reference 2 * Relationship Reference 2 Phone (###) ### #### Are you currently in school for massage therapy? Yes No If yes, when is your anticipated graduation date? MM DD YYYY What is your State of Wisconsin LMT license number? You will be asked to provide a copy of your license upon hire. Do you currently hold liability insurance? You will be asked to provide proof of insurance upon hire. Yes No What are your current additional certifications and/or preferred modalities? If you do not hold any additional certifications, what modalities do you want to pursue? Please email a copy of your resume to contact@animusmassage.com.. Thank you for your application! We will be in touch soon. Please send your resume and any additional info to tianna@bridgewellness.com
