An application for a massagist's permit, as required in Section 840.02(b), shall be made to the Department of Public Service in the same manner as provided above for massage business licenses, accompanied by the annual nonrefundable massagist's permit fee of two hundred fifty dollars ($250.00) per year or part thereof. The application shall contain, but not be limited to, the following:
(a) The business address and all telephone numbers of the place where the massage is to be practiced;
(b) The name and residence address, and all names, nicknames and aliases, of the applicant, including the two addresses immediately prior to the present address of the applicant;
(c) The applicant's social security number, driver's license number, if any, and date of birth;
(d) The applicant's weight, height, eye color, hair color and sex;
(e) Written evidence that the applicant is at least eighteen years of age;
(f) A complete statement of every conviction of the applicant for a felony or misdemeanor or a violation of a local ordinance, except misdemeanor traffic violations;
(g) Fingerprints of the applicant, taken by the Division of Police;
(h) Two front-face portrait photographs of the applicant, taken within thirty days of the date of the application and at least two inches by two inches in size;
(i) The name and address of the recognized school attended by the applicant, the dates of attendance thereat and a copy of the diploma or certificate of graduation awarded the applicant showing that the applicant has completed not less than seventy hours of instruction;
(j) The massage or similar business history and experience of the period ten years prior to the date of application, including, but not limited to, whether or not such person, in previously operating in the Municipality or State, or in another municipality or state, under license or permit has had such license or permit denied, revoked or suspended, the reasons therefor and the business activities or occupations subsequent to such denial, suspension or revocation;
(k) The names, current addresses and written statements of at least five bona fide permanent residents, other than relatives of the applicant, of the United States, that the applicant is of good moral character. If the applicant is able to do so, the statement must first be furnished by a resident of the Municipality, then by a resident of the County, then by a resident of the State and finally by a resident from the rest of the United States.
(l) A medical certificate, signed by a physician licensed to practice in the State, within seven days of the date of the application. The certificate shall state that the applicant was examined by the certifying physician and that the applicant is free of communicable disease. The additional information required by this subsection shall be provided at the applicant's expense.
(m) Such other information, identification and physical examination of the person deemed necessary by the Police Administrator in order to discover the truth of the matters required by this section to be set forth in the application;
(n) Authorization for the Municipality, its agents and employees to seek information and conduct an investigation into the truth of the statements set forth in the application and the qualifications of the applicant for the permit;
(o) A written declaration by the applicant, under penalty of perjury, that the information contained in the application is true and correct, such declaration to be duly dated and signed in the Municipality.
(Ord. 83-29. Passed 7-18-83.)