Job Application Form Application Form 1Step 12Step 2 First Name* Last Name* Street Address* City* State* Zip Code* Email* Phone*State(s) & License #(s) Year First Licensed Massage School Liability Insurance Y/N/Will Purchase ? Yes No Insurance Co. / Association How did you hear about Body Well? Are you or someone you live with a smoker? Please mark which of the following supplies you will definitely have at your disposal on short notice: Massage Table in good condition Adjustable face cradle Massage chair Linens (plain/solid color in good condition) Massage lotion/oil/cream (unscented) Essential Oil/Aromatherapy Make/Model of table What is your shirt size, for future reference? (please list in mens/womens sizes per your gender) 1. In what situations, if any, have you performed professional massage services until now (i.e. house calls, chiro offices, spas, etc.)? Home Hotel Office Spa Massage Clinic Chiropractic or PT Clinic Event Massage 2. Are there any specific modalities (other than swedish) that you feel competent performing? Please list them. 3. On a scale of 1 to 10, how would you rate your deep tissue skills? 4. List all days and hours that you are *POSSIBLY* 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) 5. PLEASE READ AND ANSWER CAREFULLY: Do you have a minimum average number of assignments per week that we *MUST* offer to you for you to be interested in joining our team? If yes, how many? 6. About how far are you willing to travel for an assignment assuming you are making at least $80?? 7a. Are you willing and able to carry your massage equipment up one flight of stairs if/when required? 7. What would be the latest start time in the evening you could possibly be available for an outcall? 8. Most work is unsupervised, so it is important that therapists agree to conform to some general policies and guidelines. On a scale of 1 to 10, what is your willingness & ability to take direction & follow instructions? 9. Are there any kinds of clients you will not work with (besides sexually suggestive), e.g. "single men", "elderly". etc.? If so please list here 10. Do you have a personal requirement that every client you touch signs a special liability waiver? (While Body Well requires that all therapist carry liability insurance, we do not require this.) Yes No 11. Are you willing to represent Body Well by wearing our provided T-shirt to assignments? 12. Are you open to receiving constructive feedback about your technique, supplies, performance, etc. either during or after the interview process? Yes No Photo (We receive applications every day. It is extremely helpful for us to put your name to a face. Please attach a photo if available.)Accepted file types: jpg, gif, png, bmp, jpeg, Max. file size: 512 MB.Attachments (doc,docx,pdf,etc)Accepted file types: doc, xls, docx, xlsx, pdf, Max. file size: 256 MB.
