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12. Nance and address of the licensed Massage Therapy Establishment that you expect to be <br />employed by. <br />12. C <br />U-YJ2'•dd{ Sl ree`i- / 3"(CCa,.�d�� <br />13. Address(es) at which you have lived during preceding ten years. (Begin with present or last <br />address, and work back.) ( o> t S S <br />X7'7 )° 0c.c t'c' — e //2 cierYtits ; A/1 0 <br />6L. ,J_ % , 11 k ter cK .. C`r CS r,4V' Z.6 ?S' iY( cL. /V1/ S' %/s <br />/2 38370. ! 4tr oiv -ST . 77' f,I Cl G'i. C C"Z .I F' / 7. CS'53 3 <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 hack.) <br />Business or Street Address Nature of Business <br />Occupation City and State Or Occupation <br />(1 Lv r- oc,;-cce: h -. r Lk(s. c.,'&44.. , <br />ika.SScLgarh.eree -?` -. c�C% r'- f rece”-Ti; r�c�"c�.. F,A, 2ov,..tia..\A. .d, <br />�".1 <br />15. Attach a certified copy of a diploma or certificate of graduation from a school of massage <br />therapy including a minimum of 600 hours in successfully completed course work as required <br />by City Code. tt. b vimC, (-rc...l •-tz_> C. +'`r <br />16. Ilave 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 the time, place, and offense for which convictions were had. <br />17. Have you been in military set-vice? Yes ✓ No <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 />9 <br />10 <br />