| Name (first, Last)* |
|
| Company |
|
| Address1* |
|
| Address2 |
|
| City* |
|
| State* |
|
| Zip* |
|
| Phone Number 1* |
|
| Phone Number 2 |
|
| E-mail |
|
| Application Type* (choose 1) |
|
| If you chose other, explain |
|
| Class Name |
|
Class/Service Description*
(Give a brief
description of the class/service you would like to give at New Age People) |
|
|
Class Cost
(Amount you would like to make per person, services are preset) |
|
| Hours Needed for Class |
|
| How were you referred to us? |
|
|
| Other Skills or Qualifications (Summarize
and training, skills, licenses, certificates, and/or other qualifications) |
|
|
Reference 1
(Name, Ph #, Years Known, Relationship) |
|
|
Reference 2
(Name, Ph #, Years Known, Relationship) |
|
|
Reference 3
(Name, Ph #, Years Known, Relationship) |
|
|
|
You must read and check the box at the bottom*
I hereby authorize the potential employer/contractor to contact, obtain, and
verify the accuracy of information contained in this application from all educational
institutions and references. I also hereby release from liability the potential
employer/contractor and its representatives for seeking, gathering, and using
such information to make employment decisions and all other persons or organizations
for providing such information. I understand that any misrepresentation or
material omission made by me on this application will be sufficient cause for
cancellation of this application or immediate termination of the employee/contractor
relationship, whenever it may be discovered. I represent and warrant
that I have read and fully understand the foregoing,
|
