The applicant for a certified massage therapist license and massage therapist in training license shall supply the following information, in such form as may be required from time to time by the Village Manager:
(A) Name and residence address;
(B) Date of birth;
(C) Social Security number and driver's license number, if any, together with copies of the Social Security card and driver's license;
(D) Applicant's weight, height, color of hair and eyes;
(E) Written evidence that the applicant is at least 18 years of age;
(F) Business, occupation, or employment of the applicant for the three years immediately preceding the date of application;
(G) The business where the applicant intends to work; and
(H) A statement whether the applicant has ever been arrested or convicted on a charge of committing any criminal offense or local ordinance violation except minor traffic violations, and whether the applicant has ever pleaded guilty or no contest to any such charge, or had any bond forfeited in connection with any such charge. If the answer is in the affirmative, a statement must be made giving the place and the court in which such conviction, plea, or forfeiture was had, the specific charges under which the conviction, plea, or forfeiture was obtained, and the disposition or sentence imposed as a result;
(I) A statement that the applicant is of such good character and reputation in the community, which character and reputation may be determined by previous arrest record, association with persons known to lack good moral character, open and notorious criminal sexual activity, or other acts of moral turpitude, or other conduct contrary to good morals;
(J) The applicant shall submit fingerprints and two 2" by 2" photographs of the applicant, one showing a front view of the applicant and one showing a side view of the applicant.
(K) With respect to certified massage therapist applications, either a copy of a diploma in massage therapy from an educational institution accredited by a state or any state government agency, or a certificate from having passed the National Certification Examination for Therapeutic Massage and Bodywork (NCBTMB), and proof of being an active member of a nationally recognized massage therapy association, as a certified, professional, or equivalent level;
(L) A massage therapist in training shall submit evidence that they are actively enrolled in the field of massage therapy in an educational institution accredited by the state or any agency thereof, or by any other state or agency thereof.
(Ord. 97-01, passed 10-3-01)
Cross-reference:
Licenses not transferable, see § 128.05