General Information Name * Email * Address Phone * DOB Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999 City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Full or Part time? Part Time Full Time Cosmetology License# Have you previously applied with Blanc Noir Hairdressing? No Yes Have you been convicted of a state or federal felony? If yes, please explain Are you licensed in any other states and/or countries? If so, which ones? Referred by Are you presently employed? No Yes May we contact your employer? No Yes Date you can begin working Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20132014 Employment ExperienceEmployment 1 Employer Phone Title Supervisor Reason for Leaving Employed From Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Employed To Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Compensation/Salary Duties Performed Employment 2 Employer Phone Title Supervisor Reason for Leaving Employed From Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Employed To Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Compensation/Salary Duties Performed Employment 3 Employer Phone Title Supervisor Reason for Leaving Employed From Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Employed To Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Compensation/Salary Duties Performed Education Name & City of Cosmetology School Date Started Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Date Graduated Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Name & City of University Date Started Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Date Graduated Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Please list all advanced courses, training, educational seminars, and conferences you have attended: Please list all professional memberships that will be beneficial to your work in this position: ReferencesList three references (include two professional references)Reference 1 Name Phone # Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Title and/or relationship Reference 2 Name Phone # Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Title and/or relationship Reference 3 Name Phone # Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Title and/or relationship Agree Blanc Noir Hairdressing is an At Will Employer where the employee is free to resign at will at any time with or without cause. Similarly, Blanc Noir Hairdressing may terminate the employment relationship at will at any time, with or without cause. I certify that the answers given are true and correct to the best of my knowledge. I authorize Blanc Noir Hairdressing to verify any representations made by me either oral or written concerning personal employment, financial and/or other related matters as may be necessary in arriving at an employment decision. I understand that Blanc Noir Hairdressing may contact individuals or organizations other than these I have provided as a reference in this process. I hereby release all employers, companies, corporations, credit bureaus, law enforcement agencies, schools, or persons from any and all liability in responding to inquiries in connection with this application. In the event of employment, I understand that false or misleading information given in this application (or any interviews) may result in discharge. I also understand that the prior written consent of Blanc Noir Hairdressing is required for participation in outside ventures or additional employment should I enter into an employment agreement with Blanc Noir Hairdressing. Word verification * (verify using audio) Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.