1404 Battlefield Boulevard North Chesapeake, Virginia o. (757) f. (757)

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1 Salon asters Application for Booth Rental Equal access to programs, services and independent contractor status is available to all persons. Those applicants requiring special accommodations to fill out the application and/or interview process should notify the company's manager, owner or Salon Coordinator. Requesting to Rent Space to Perform Services: Date of Application: / / Referral Source: (circle one) Walk-in Other: Advertisement Employment Relative Employment Agency School Referral First Name: Last Name: City: State: Zip Code: Home Telephone#: Cell Phone#: Pager: Social Security#: - - Date of Birth: (onth/day/year) / / Have you submitted an application here before? Yes No If yes give date / / Have you been employed or rented space before? Yes No If yes give date / / Are you legally eligible for employment in this country? Yes No Are you able to meet the legal requirements to obtain a Yes No rental booth? With our assistance are you willing to obtain the neces- Yes No sary legal documents? Have you been convicted of a crime in the last seven (7) Yes No years? If Yes, please explain: CONVICTION WILL NOT NECESSARILY BE A BAR TO EPLOYENT. EACH INSTANCE AND EXPLANATION WILL BE CONSIDERED IN RELATION TO THE POSITION FOR WHICH YOU ARE APPLYING. Employment/Rental History

2 Salon asters Provide the following information for your past and current employers, booth-rental agencies, assignments or volunteer activities starting with the most recent. Explain any gaps in working in comment section below.

3 Salon asters Please Check the Following Items That You Have In Place At This Time: Cosmetology License Professional Liability Filed Personal In- Business Privilege Insurance Come Taxes For Past License Three Years Ein-Employers Business Bank Ac- Business Plan DBA or Fictitious Identification Number count Name Registration Skills and Qualifications - (summarize any special training, skills, licenses and/or certifications that may qualify you as being able to perform the contractor related services for which you are applying.) Educational Background List three (3) schools attended, starting with the most recent.

4 Salon asters ajor: ajor: ajor: References List the name and telephone number of three business/work references who are not related to you and are not previous supervisors, if necessary include school or personal references not related to you. Name Contact # Years Known I understand that if I enter into an agreement with the Company, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of any Agreement made, whenever it is discovered. I give the Company the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the Company and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishings information. The Company does not unlawfully discriminate in its contracting/rental agreements and no question on this application is used for this purpose of limiting or excusing and applicant from consideration for entering into an Agreement with the Company on a basis prohibited by local, state, or federal law. This application is current for only sixty (60) days. At the conclusion of this time, if one has not heard from the Company and still wishes to be considered for a contract position, it will be necessary to fill out a new application. This application does not constitute and agreement or contract of any kind for any specified period of definite duration. I understand that no representative of the Company, other than and authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer. I understand it is this company's policy not to refuse to enter into an Agreement with qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA. I also understand that if I enter into an agreement with the Company, I will be required to provide proof of identity, legal work authorization, and proof of professional licensing. I represent and warrant that I have read and fully understand the forgoing and seek an Agreement with the Company under these conditions.

5 Salon asters Signature of Applicant Date / /