Permit Application for Person(s) Engaged in Massage Therapy

Personal Information
Address

Apt., Suite, etc.

Applicant
Two (2) Previous Addresses Prior to Current Address
Previous Address One

Apt., Suite, etc.

Previous Address Two

Apt., Suite, etc.

Have you ever been convicted of a felony or a crime involving moral turpitude, a crime involving controlled dangerous substances, or an offense involving sexual misconduct, or an offense involving the use of force or violence upon someone, or any other crime that would amount to a felony? If your answer is yes to any of the above questions explain in detail.

List all prior massage or similar business experience for the past ten (10) years and the City & State. If the applicant ever had a license or permit to perform massage therapy suspended or revoked please explain.

Authorization
I, the applicant, do hereby authorize the City of Moore, it`s agents or anyone designated by the City of Moore, to contact any source to verify the information supplied in this application.
Declaration
I, the applicant, do hereby authorize the City of Moore, it`s agents or anyone designated by the City of Moore to contact any source to verify the information supplied in this application.

VANESSA KEMP
City Clerk
[email protected]

CITY CLERK`S OFFICE
City Hall
301 N. Broadway
Moore, OK 73160

405-793-5020