Therapist Application
Name:
Address:
City:
State:
Zip:
E-mail:
Best number to reach you:
Fax:
List days and hours you
are willing to work
Do you have liability insurance?
Yes
No
Check the license(s) you have:
State
City
Years of experience:
Do you have access to a massage
chair and/or table
Yes
No

How much notice do you
need to start work?

What is your favorite
massage modality?
Do you have reliable transportation?
Yes
No
Do you have valid
automobile insurance?
Yes
No

In short describe what
your strengths are:

Please list 2 references with contact information and best number to call:


Click Here To Send
Photo Attachment

Have you read and signed the Independent Contractor's
non-compete contract?

Yes
No
Have you read and signed the Independent Contractor's agreement?
Yes
No
Please fax forms to:  480-718-9405