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12. Name and address of the licensed Massage Therapy Establishment that you expect to be <br />employed by. <br />13. Address(es) at which you have lived during preceding ten years. (Begin with present or last <br />address, and work back.) <br />h MA) 3-6;1- 7/ <br />�C.. Cs_ �GrGa - <br />wThc e..., 2 lc) - /S--U S 6_,,Q.. Za as <br />4. , Kind, name, and location of every business or occupation you have been engaged in during <br />1 g <br />i the preceding ten years. (Begin with present business and work back.) <br />Business or <br />Occupation <br />Street Address <br />City and State,. <br />Nature of Business <br />Or Occupation <br />/ <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. <br />"A ... .1 <br />Have you ever been convicted of any felony, crime, or violation of any ordinance other than <br />traffic? <br />Yes <br />If yes, given information as to the time, place, and offense for which convictions were had. <br />17. Have you been in military service? Yes <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 />20 <br />