Please Print Out and Mail, Fax, or Deliver to Baby Belly Spa
Mail: 2160 Sir Barton Way Suite #115 - Lexington, KY 40509
Fax: (859) 272-1452
Applicant Information
Full Name: Date:
Last Name First Name MI
Address:
Street Address Apt # City State ZIP Code
Phone: Email:
Date Available: Social Security No: Desired Salary:
Position Applying for:
Are you a U.S. Citizen? YesNo If no, are you authorized to work in the U.S. ? YesNo
Have you ever been convicted of a felony? YesNo
If yes, Explain.
Education
High School: Address:
From: To: Did you Graduate? YesNo
College: Address:
From: To: Did you Graduate? YesNo Degree?
College: Address:
From: To: Did you Graduate? YesNo Degree?
College: Address:
From: To: Did you Graduate? YesNo Degree?
Please Give 3 Professional References
Full Name: Relationship:
Company: Phone:
Address:
Full Name: Relationship:
Company: Phone:
Address:
Full Name: Relationship:
Company: Phone:
Address:
Previous Employment
Company: Phone:
Address: Supervisor:
Job Title: Starting Salary: Ending Salary:
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous Employer? YesNo
Company: Phone:
Address: Supervisor:
Job Title: Starting Salary: Ending Salary:
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous Employer? YesNo
Company: Phone:
Address: Supervisor:
Job Title: Starting Salary: Ending Salary:
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous Employer? YesNo

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.