Professional Contractor Information

    Contractor First & Last Name:*

    Massage License #:

    Upload Professional license if scanned copy

    Date Issued:*

    Driver License, Personal Identification Number:

    Upload Driver license if scanned copy

    Massage Insurance Name:*

    Policy #: Esthetician* YesNo

    Esthetician License Number:

    Additional Holistic Certifications:

    * * * * * Days/Times Unavailable For Work, If Available leave Blank Monday Hours

    TuesdayHours

    WednesdayHours

    Thursday Hours

    FridayHours

    Saturday Hours

    SundayHours

    PROFESSIONALS CONTACT:

    Phone #:*

    Full Address

    Social #:*

    Emergency Contact Name & Number:*

    Professional Massage License Conduct Discrepancies/Deviations:*

    Select* YesNo

    If Yes Please Detail:*

    Professional Esthetician License Conduct Discrepancies/Deviations:*

    Select* YesNo

    If Yes Please Explain:*

    Select* YesNo

    If Yes Please Detail:*

    DIRECT DEPOSIT INFORMATION*

    Bank Name:*

    Bank Type* BusinessPersonal

    Business/Practice Name:

    Account #* Routing#* Account Type*

    Email:*

    Preferred Phone Number For Accepting Appointments #:*

    I certify that the information submitted in this application is true and correct to the best of my knowledge. I further understand that any false statements may result in non-acceptance or revocation of the Eminence Massage LLC Contract.

    In exchange for the consideration of my contract position with Eminence Massage Limited Liability Company, FEI/EIN 80 – 0840106. Document Number L12000101279. I agree that neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of Independent Contractor handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other company practices, shall serve to create an actual or implied contract of hiring or to confer any right to remain an independent contractor of Eminence Massage or otherwise to change in any respect the Independent contractor-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /Owner/Manager of the Company. Both the undersigned and Edna King may end the contract relationship at any time, without specified notice or reason. While in position with the company, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this contract. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the company permission to contact schools, previous employers, contractors (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. I further understand that continued work may be based on the successful passing of job-related physical examinations. I understand by becoming an independent contractor with Eminence Massage LLC I will be provided compensation of services and I understand that, in connection with the routine processing of a daily 7pm direct deposit, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, back round checks, license checks, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. If I fell to honor these terms I will be subject to immediate termination and may face legal prosecuting. I understand that I, as an Independent contractor with Eminence Massage, I am responsible to file my taxes accordingly with provided 1099 forms provided at the beginning of each year. I understand do to certain areas (Geographic, seasonal changes, city, or local community activities and weather conditions) contracted work with Eminence Massage may flourish or decline, do to consumers/clients leisure, contractors repeat calls will also induce or reduce consumer/clients in specific areas. I understand and give consent to using company privy information will not be abused in any manner and are only for purposes of guiding my talents, skills and understanding as a mobile massage therapist. I understand Generally Eminence Massage Will pay a percentage of published rates for all mobile spa services, which can be viewed on the companies work/advising forms and explained more thoroughly upon hiring. Eminence Massage LLC understands that screening clients is a legitimate concern. If consumer/client cancels upon therapist arrival do to emergency, work related or personal reasons, or of Consumer/client is deem unfit to receive massage service, therapist will be compensated for entirety of the regular priced massage session example (under the influence of any drug or alcohol related substances, inappropriate gestures or advances at beginning or during time of session) prices are fully subject to change if I therapist/esthetician declines session. I understand generally Eminence Massage LLC will receive some calls with gender preference, however company will fairly and equally best distribute services to all contracted professionals in consideration to consumers request. We understand that screening clients is a legitimate concern. I understand that if I become temporarily unable to perform accept any appointments do to a medical condition related to pregnancy or illness, trauma or obtain a medical condition which can inhibit my performance and position as a Independent Contractor with company I will not accept appointments during this period. If I choose I can also by choice inform Eminence Massage company to remove me from contract roster for a certain period and be added on once I am fit to take appointments. I understand if by choice I do not accept appointments for over a period of two months without providing the company cause I can be subject to be having my contract terminated with Eminence Massage LLC company. I understand that becoming an independent contractor with Eminence Massage, I will honor the terms of each financial transaction whether monies owed or due to the company and such forth to my self. I will not solicit my personal services to Eminence Massage or offer any unprofessional services to clients. If I fell to honor these terms I will be subject to immediate termination and may face legal prosecuting. I further understand that my work with the Company and contract relation with the Company is terminable at will for any reason by either party. I hereby authorize any person, or company I have listed or mention as a reference on my written or verbal employment application /consent to disclose in good faith any information they may have regarding my qualifications and fitness for employment/work. I understand that while contracted with Eminence Massage Llc if by choice I will be may use all network and social media platform guidelines and policies in a reputable manner and respectable manner toward both company and other professionals. If I fell to honor these terms I will be subject to immediate termination and may face legal prosecuting. I understand I will immediately summit any change of contact information such as change of address or phone number to the provided and appropriate information form diligently while once contracted with Eminence Massage LLC. I understand that any specified uniformed provided by Eminence Massage LLC will be used in strict accordance to company standards and in appropriate setting of a specified service, I will keep uniform fit for contracted work and not use or mis-represent the Eminence Massage name/logo/brand in any way, if uniform is not deemed necessary for a specific service I will dress according to that of an on site spa professional provided in Eminence Massage LLC guidelines. I will abide by regulations of having professional liability insurance and appropriate license forms at all times and understand as an independent contractor, I am responsible for providing my own liability insurance while catering on site professional spa services with Eminence Massage. I understand that given insurance and license information is subject to verification yearly and at Eminence Massage LLC discretion, I will update Eminence Massage Manager if their are any changes to my address or practice insurance. I will inform company manager/registered agent of any discrepancies ever obtain on my license immediately. I will hold Eminence Massage, any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the contracting process. I understand By typing my name, Initials and providing information below I agree to terms and conditions of contract.

    Initials*:

    Date: