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Capilo Registration Form :

Full Name

(Required)

Address

 

City / Town

 

State

 

Zip

 

Phone

(Required)

E-mail Address

(Required)

Date Of Birth

 

Social Security Number

 

Drivers Licence #

 

Course of Interest

 

Course Start Date

 


Education:

 

 

Yes

No

High School Name

Graduate?

College Name

Graduate?

Vocational School

Graduate?

GED

 

 

43 Bridge Street
 Augusta, Maine  04330
 
1-207-621-9941
 

 Hours:

Monday

9 - 5

Tuesday

9 - 5

Wednesday

9 - 5

Thursday

9 - 5

Friday

9 - 4

 

Starting Date:
 
Leaving Date:

Job Title:

Supervisor (Name):

Employer Phone:

EMPLOYMENT BACKGROUND:

1. Name and Address of Present or Last Employer:
Check box if still employed with this employer:

Description of Work:

2. Name and Address of Previous or Last Employer:

Description of Work:

 

Starting Date:

Leaving Date:

Job Title:

Supervisor (Name):

Employer Phone:


3. What skills or qualities do you currently have that will help you in your training?

4. What is your financial plan for school?

5. Do you plan on working while attending school?          Yes     No        

If so, where?    (Check box if same as Present Employer listed above )


References:

6. Please list three references below:

  Name                                 Address                               Phone

Additional Comments : 

 

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Member of the
American Aestheticians Education Association

Member of the
American Association of Cosmetology Schools

 

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