Name:__________________________________________________

Social Security#________________ Driver LIcense/ID____________

Address:________________________________________________
Phone:__________________________________________________
Emergency
Phone:__________________________________________

Email
address______________________________________________
Social Media & Website
__________________________________________________________
__________________________________________________________
Have You ever work in a Tattoo Shop ?Yes___ or No___
Put N/A in spaces that does not Apply tp you.
How long have you been Tattooing?_____ Body Piercering_____
Tattoo Reversal_____

Do You Have Customers/Clientele?_______

Do You no how to self promote?________
Are you any legal or financial troubles that are pending?
Yes____ or No ____
Do You Have transportation? Yes ____ or No ____
Have you taken the bloodborne pathogen and is your certificate
current? Yes ____ or No _______

Signature____________________________ date___________