My WebLink
|
Help
|
About
|
Sign Out
Home
2008_0825_packet
Roseville
>
City Council
>
City Council Meeting Packets
>
2008
>
2008_0825_packet
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
2/15/2012 1:34:50 PM
Creation date
12/28/2011 1:35:39 PM
Metadata
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
284
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
New License <br />For License year ending, June 30 <br />J <br />I., Legal Namejy//00-4&— <br />Renewal Y, <br />. El <br />FA n4w a, <br />2, Home Address <br />3. Home Telephone <br />4. Date of Birth <br />51. Drivers License Number 0 1 1 <br />6. Ernail Address <br />7. Have vou ever, used or been kn7n by any name other than, the legal name given in number 1 above? <br />Yes No f yes, list each name along with dates and places where used. <br />8. Na e d a <br />ddrPs of the licensed Massage Therapy Establishment that you expect to be employed by. <br />9 1 <br />Attach a certified copy of a diploma or certificate of graduation from a school of massage therapy <br />including a mini mum i <br />of 600 hours n successfully completed course work as describPO in Roseville <br />Ordinance H 6, mas,sage Therapy Establishments. <br />f <br />10. Have you had any previous rnas3ekl-e-""therapist license that was revoked, suspended, or not renewed? <br />Yes Nol – If yes expilain in detail. <br />License fee is 75.00 <br />flake checks pay'ablle to City of Roseville <br />
The URL can be used to link to this page
Your browser does not support the video tag.