Form B-37 - Application For Barber Licensure (Page 2 of 2) in pdf

Form B-37 - Application For Barber Licensure Page 2

APPLICATION FOR LICENSURE

ADDENDUM

A. CHARACTER REFERENCES: Please provide the names and addresses of three character references below.

_______________________________

_________________________________

_______________________________

_________________________________

_______________________________

_________________________________

B. WORK EXPERIENCE: List your work experience including employers names, addresses, phone numbers and dates of

practice.

NAME OF SHOP _________________________________ EMPLOYERS NAME _________________________________

ADDRESS of SHOP ___________________________________________________ PHONE NO. _____________________

DATES of PRACTICE _______________________________ TO _______________________________________________

NAME OF SHOP _________________________________ EMPLOYERS NAME _________________________________

ADDRESS of SHOP ___________________________________________________ PHONE NO. _____________________

DATES of PRACTICE _______________________________ TO _______________________________________________

NAME OF SHOP _________________________________ EMPLOYERS NAME _________________________________

ADDRESS of SHOP ___________________________________________________ PHONE NO. _____________________

DATES of PRACTICE _______________________________ TO _______________________________________________

If more space is needed, attach a separate sheet of paper

_______________________________________________________________________________________________________

C. PHOTOGRAPH: Attach 2 original 3”X 2” bust only photographs of yourself below.

HEIGHT

_____________

WEIGHT

_____________

ATTACH PHOTOGRAPHS HERE

EYE COLOR

_____________

HAIR COLOR _____________

OTHER DISTINGUISHING FEATURES

___________________________________________

B-37 revised 11/99

Form B-37 - Application For Barber Licensure Page 2