info@capilo.com
Registration Information
Contact Information
Name
(Required)
Address
City
State
Zip
Phone
E-mail Address
DOB
SSN
Drivers Licence #
Course
Select One Barber Program Cosmetology Program Manicurist Program Esthetician Program Instructor Program Advanced Program Spa Therapy Medical Esthetician
Course Start Date
Education
YES
NO
High School Name
Graduate?
College Name
Vocational School Name
GED
EMPLOYMENT BACKGROUND:
1. Name and Address of Present or Last Employer:
Check box if still employed with this employer
Description of Work:
Starting Date: Leaving Date: Job Title: Supervisor (Name): Telephone No:
Leaving Date:
Job Title:
Supervisor (Name):
Telephone No:
2. Name and Address of Last Employer:
3. What skills or qualities do you currently have that will help you in your training?
4. What is your financial plan for school?
Yes No
5. Do you plan on working while attending school?
If so, where? (Check box if same as Present Employer listed above )
References:
6. Please list three references below:
Additional Comments : Have someone contact me.
Member of the American Aestheticians Education Association and the American Association of Cosmetology Schools
and the
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