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12. Name and address of the licensed Massage Therapy Lstablishrnent that you expect to be <br />employed by. <br />V c~U ~~~,jl <br />13. Address(es) at which you have lived during preceding ten years. (Begin with present or last <br />address, and work back.) <br />~~ti~ ~ <br />L ~ r /1 lv'"~.~jAl ~F.~n ~q /'~ <br />- --~- <br />~. <br />_. <br />14. Kind, name, and location of every business or occupation you have been engaged in during <br />the preceding ten years. (Begin with present business and work back.) <br />Business or Street Address <br />Occupation City anct State <br />i00_ <br /> <br />Nature of Business <br />Or Occupation <br />c <br />}c~~ C~cY~ <br />15. Attach a certified copy of a diploma or certificate of graduation from a school of massage <br />therapy including a minimum of 60U hottts in successfully completed course work as required <br />by City Code. <br />1C. Have you ever been convicted of any felony, crime, or violation of any ordinance other than <br />traffic`? <br />Yes ~ No <br />If yes, given information as to tlae time, place, and offense for which convictions were had. <br />17. Have you been in military service? Yes _ `/ Na <br />If yes, was discharge(s) ever other than honorable? <br />Yes _~_ No <br />(Upon request, you may be required to exhibit all discharges.) <br />n <br />