Application for Massage THERAPIST

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

What is your LMT license number? *

How many years have you practiced as a licensed massage therapist?

What do you consider your speciality in massage? *

What Massage Modalities are you certified in?

• Neuromuscular Therapy
• Prenatal
• Myofascial
• Lymphatic Drainage
• Medical Massage
• Other

Describe your Massage Modality certifications

Do you have experience with any Alternative Healing, or Energy Healing Modalities? *

• Yes
• No

What Alternative Healing modalities are you experienced with?

How did you find out about this position?

• Current Employee
• Ziprecruiter
• Facebook
• Instagram
• Website
• Other

If other

Upload your resume *

Click or drag a file to this area to upload.

Anything else you would like us to know about you.

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