Apply Online PRE-EMPLOYMENT QUESTIONAIRE EQUAL OPPORTUNITY EMPLOYER *required field PERSONAL INFORMATION First Name * Middle Name Last Name * Address * City * State * Zip * Home Phone * Alt. Phone Email * Referred By Have you applied with us before? * Yes No When? EMPLOYMENT DESIRED Can you work evenings and Saturday's? * Yes No If no, why not? Position applied for? * [select] Front Desk (Client Coordinator) Medical Esthetician Esthetician Massage Therapist Nail Technician Other Position Date you can start * Salary/Rate expected * What kind of work are you looking for? * Full Time Part Time Temporary Are you employed now? * Yes No If so, may we inquire of present employer? Name(s) of any family members employed by us EDUCATION High School Name / City / State * Area of study * Did you receive a degree or certificate? * Yes No If yes, type of degree or certificate Grade Average * College University Name / City / State Area of study Did you receive a degree or certificate? Yes No If yes, type of degree or certificate Grade Average Professional Certification Name Type Date Granting Organization Professional Certification Name Type Date Granting Organization SPECIAL AREAS OF INTEREST, TRAINING OR SKILLS USEFUL IN THE SPA INDUSTRY EMPLOYMENT HISTORY (most recent first) Employer #1 Name Address City State Zip Phone Number Date Hired Date Separated Final Rate of Pay Job Title Immediate Supervisor Describe the nature of your duties Reason for leaving Employer #2 Name   Address City State Zip Phone Number Date Hired Date Separated Final Rate of Pay Job Title Immediate Supervisor Describe the nature of your duties Reason for leaving Employer #3 Name   Address City State Zip Phone Number Date Hired Date Separated Final Rate of Pay Job Title Immediate Supervisor Describe the nature of your duties Reason for leaving ADDITIONAL INFORMATION Have you ever been discharged from any of the above positions? * Yes No If yes, please explain Were you ever employed by any of the above employers under a different name? * Yes No If yes, which name and employer? Have you ever been arrested? * Yes No If yes, please explain Have you ever been convicted of a felony? * Yes No If yes, please explain Have you ever been placed on deferred adjudication? * Yes No If yes, please explain What office/ computer/ accounting/ cash register skills do you have? Do you speak a foreign language? * Yes No If yes, which one? Do you smoke? * Yes No REFERENCES (non-relatives) Reference #1 Name * Phone Number * Occupation * Years Known * Reference #2 Name * Phone Number * Occupation * Years Known * Reference #3 Name * Phone Number * Occupation * Years Known * AUTHORIZATION I certify that the facts contained in this application are true and complete to the best of my knowledge, and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements, references and employers listed above, and release European Skincare Institute from all liability or damage that may result from utilization of such information. This waiver does not permit the release or use of disibility-related or medical information a manner prohibited by the American with Disibilities Act (ADA) and other relevant federal and state laws. European Skincare Institute is an Equal Opportunity Employer, and provides a drug-free work place, and I understand that I will be abide by my employer's drug and alcohol abuse policy. I Agree