Eminence Massage Online Application

First Name*

Last Name*

Your Email*

Street Address*

City*

State*

Zip Code*

Phone Number*

Languages Spoken*

Social Security*

Emergency Contact Name*

Emergency Contact Phone Number*

Position Desired With Company*

Massage TherapistEstheticianCosmetologist

Year Licensed*

License #*

Are you fully insured to perform services in your profession? If not, how soon can you obtain your insurance?*

YesNo

Time length to obtain insurance?

Insurance Co. / Association Name

Name of Professional Certification School

Hours Completed

Graduation Date

Dates Attended

From (mm/yyyy) To (mm/yyyy)

Extra Certifications/License/Training in Scope

Employment History

Name of Company 1

Job Title

Supervisor’s Name

Employer's Street Address

City

State

Zip Code

Phone Number

Employment Period

From (mm/yyyy) to (mm/yyyy)

Responsibilities & Skills

Name of Company 2

Job Title

Supervisor’s Name

Employer's Street Address

City

State

Zip Code

Phone Number

Employment Period

From (mm/yyyy) to (mm/yyyy)

Responsibilities & Skills

Name of Company 3

Job Title

Supervisor’s Name

Employer's Street Address

City

State

Zip Code

Phone Number

Employment Period

From (mm/yyyy) to (mm/yyyy)

Responsibilities & Skills

Please check which kinds of assignments you are interested in:

Home Outcalls (Condos / Yachts / Houses / Apartment)Hotel Outcalls (In Room Hotel Suite / Hotel Spa Rooms)Chair Massage (Corporate / Business / Office Events)Spa Parties (Bridal Showers/ Birthdays / Anniversaries / Charities / Sporting Events)

How did you hear about Eminence Massage?

ReferralInternetNewspaperRadioYellow PagesOther

Are you looking for a career that will allow you more professional freedom?

YesNo

Do you have a desire to help others?

YesNo

Do you see yourself as a nurturing person?

YesNo

Would you like having a flexible work schedule?

YesNo

Do you enjoy working one on one with people?

YesNo

Do you consider yourself a good listener, with positive interpersonal skills?

YesNo

Would you enjoy working in various calm healing and even zestful spa ambiance environments?

YesNo

Can you perform side by side with other professionals in various settings such as spa parties, corporate or chair massage events?

YesNo

Do you have access to smart phone?

YesNo

List ALL days and hours that you are available and would like to be offered an open assignment? (Keep in mind that you are never obligated to accept an offered assignment. You can also update this later as your availability changes)

How far are you willing to commute for an assignment?

What would be the latest start time in the evening you could possibly be available for an out call?

Are there any kinds of clients you will not work with (besides sexually suggestive), e.g. "single men", "geriatric" children. etc.? If so please list here

Are you willing to represent Eminence Massage by wearing suitable clothing for the treatments you are providing? Such as white scrubs, white tunic, white linen pants or jeans. Uniforms must be completely free from any heavy scents such as perfume, cologne or smoke. Eminence massage will provide uniformed shirts for spa parties, sponsored events and any corporate or chair massage event. For any event we will structurally provide your uniform in advance.

YesNo

Applicant agrees to be on time as scheduled; to act and behave courteously professional toward clientele; to keeping the SAFE, CLEAN, CALM, COMFORTABLE set up/environment for both professional & clients; and to adhere to updated Mobile Spa policies

MASSAGE THERAPIST

As a Massage Therapist would you enjoy coaching people on better ways to care for their bodies?

YesNo

Are you interested in learning about human anatomy and how the body moves and functions?

YesNo

Do you enjoy working with your hands?

YesNo

How many massages do you feel most comfortable providing in a day?

As a massage therapist on a scale from 1-10 what is your comfort level performing body wraps and body scrubs? Assuming you were taught in massage school. If not you will be fully coached on performing these treatments.

—Please choose an option—12345678910

Have friends/family told you that you would make a great massage therapist?

YesNo

Are there any specific modalities of massage that you feel most comfortable performing? Please list them.

In what situations, if any, have you performed professional massage therapy until now (i.e. house calls, chiropractic offices, spas, etc.)?

HomeHotelOfficeYachtsSpaSalonMassage ClinicChiropractic or PT ClinicEvent Chair MassageSponsored EventsOther

Massage Therapist Equipment

You will be required to provide upon applying for work with Eminence Massage, specified equipment to utilized by you as a professional practitioner in your trade. Please mark which of the following supplies which you as a certified professional being massage therapist, esthetician or cosmetologist can assertively carry out mobile spa treatments on short notice:

Massage Table in good conditionAdjustable face cradleBattery Operated CandleEminence Body Scrub MaterialEminence Body Wrap MaterialPortable Music Material (Radio w/c.d or Smart Phone w/itunes, pandora)Fresh Linens (plain/solid color in good condition)Massage Lotion / Creams - None ScentedEssential Oil/Aromatherapy

ESTHETICIANS

As an Esthetician would you enjoy coaching people on there skin?

YesNo

Have friends/family told you that you would make a great skin care specialist?

YesNo

What would you say is your most skin enhancing treatment you have performed on a client?

Have you ever performed a body wrap or a body scrub treatment?

YesNo

In what situations, if any, have you performed professional skin care services until now (i.e. house calls, chiropractic offices, spas, etc.)?

HomeHotelOfficeYachtsSpaSalonMassage ClinicChiropractic or PT ClinicEvent Chair MassageSponsored Events

Esthetician Equipment

Facial ScrubsRecommended Facial ProductsCleanserTonerMaskEye CreamMoisturizerCotton Tipped ApplicatorsCotton Rounds

COSMETOLOGIST

Have you been told you have great skills treating nails?

YesNo

As a makeup artist, do you feel you have a talent/passion for enhancing a persons natural beauty?

YesNo

Can you provide light make up tips to clients?

YesNo

Choosing from 1-10. How would you rate you customer service skills when applying makeup to clients, can you course clients through the makeup you are applying and take request confidently.

—Please choose an option—12345678910

Do you have a full comfort level of beautifying clients hands and feet (nails)?

YesNo

Can you perform light hand and feet scrubs in addition to manicure and pedicure sessions?

YesNo

How many mani’s and or pedis do you feel most comfortable performing in a day?

What is your comfort level with creating nail designs on a scale of 1 - 10?

—Please choose an option—12345678910

We comply with many given state laws of not providing manicure and pedicure services from home, Eminence Massage will provide hand and feet massage, & hand and feet scrubs. Files, buffers, coats, color polish, clippers, feet cleansers and nail dryer spray, we will provide no cuticle work.

Upload Resume (Max file size 2MB)

Photo (We receive applications every day. It is extremely helpful for us to put your name to a face and know some what how you will present yourself to Eminence Massage Clients. Please attach a photo if available.)

Upload Photo (Max file size 2MB)

Do you fully understand your right to refuse mobile spa treatments in situations such as:

• Broken Skin Or Lesions

• Misconduct. Such as, solicitation or suggestive inappropriate comments.

• Implacable environmental discomfort.

• Any medical conditions not mentioned at time of reservation or on intake form.

• Intoxication by alcohol usage.

• Pregnancy. If treatment to be given is deemed inappropriate for pregnant women.

YesNo

Certification: I hereby certify, under the penalty of perjury that the information herein and/or attached is true and correct. I understand that providing false information or with holding information, are grounds for immediate termination of contract.

Print Name*

Date*

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