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Massage Therapists/Business Survey <br />(6) The name(s) and <br />address(es) of the <br />applicant's employer <br />(s) or partner(s), if <br />any, for the preceding <br />five years <br />(7) Whether the <br />applicant has ever <br />been convicted of a <br />crime other than a <br />traffic violation and, if <br />so, the time, place, <br />and offense for each <br />(8) Whether the <br />applicant has any <br />training or experience <br />in performing <br />massage services, <br />including any <br />certifications, <br />degrees, diplomas, or <br />educational <br />coursework <br />(9) A general physical <br />description of the <br />applicant <br />(10) A copy of <br />identification, such as <br />a driver's license, for <br />the applicant <br />(11) The length of <br />experience in this <br />occupation and the <br />past places of <br />employment and <br />positions held <br />(12) The name and <br />address of any <br />training institutions <br />attended and the <br />dates of such <br />attendance <br />0 <br />0 <br />0 <br />0 <br />O 0 0 0 <br />O 0 0 0 <br />O 0 0 0 <br />O 0 0 0 <br />O 0 0 0 <br />O 0 0 0 <br />O 0 <br />0 <br />0 <br />Page 6 <br />