Stylist Brokers LLC P.O. Box 8017 West Chester, OH 45069 www.StylistBrokers.

com 800-660-4221

Personal Information
Date ____________ Social Security Number ______________________ Date of Birth __________________________

Name __________________________________________________

Present Address ____________________________ City _______________________ State _________ Zip __________ Home Phone _____________________ Cell Phone _____________________ Other ____________________

E-mail Address ____________________________________________________________________________________ Please share your most outstanding qualities: __________________________________________________________ Where do you currently work and for how long? ________________________________________________________ Do you have a contract? Yes / No If Yes, when does it expire? _________________________________________

Why do you want to leave? ____________________ Avg Weekly Service Revenue? ___________________________ % Retail-to-Service? __________________________ Can Service & Retail totals be verified with reports? Yes / No Do you have a clientele that will follow you? Yes / No If Yes, how many 'core clients' do you think you have? _____ What Color and Retail products lines are you familiar with? _______________________________________________

New Employment Situation Desired

Salon/Spa you'd like to work for ________________________ Date you can start ____________________________ Do you want Full-Time or Part-Time? ________________ Hourly, Commission or Salary Desired ________________ Do you have any other requirements? ________________________________________________________________ What is most important to you with a new employer? ___________________________________________________ Please share any additional skill, training, qualifications, awards and honors you've achieved ___________________ ________________________________________________________________________________________________

Education History
Name & Location of School High School College Trade, Business or Correspondence School Special Focus Courses Years Attended Did you Graduate? Subjects Studied

Past Work Experience

(Please list your MOST RECENT experience first)

Date Month and Year From To From To From To From To

Name & Address

Income

Position

Reason for Leaving

References
(List Information below of persons not related, whom you have know for over one year)

Name

Address

Phone Number

Business

Years Known

Availability
What is your availability? Please list days and hours you are available and willing to work:

Monday
AM: PM:

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Authorization
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. Date: ______________________ Signature: ____________________________________________