Aesthetic Laser Training Academy Application Form

Personal Information

First Name*:

Last Name*:

Phone Number*:

Cell Phone Number:

Your Email*:

Date of Birth*:

Gender*:

Address*:

City*:

Province*:

Postal Code*:

Occupation*:

Employer Name*:

Employer Contact Number*:

Education Information

Level(s) of Education*:

Provide Details*:

Personal Health

Do you have any medical or health concerns?*

Please specify*:

Please check any of the health conditions that pertain to you*:

Please communicate any allergies*:

If yes, please specify*:

Emergency Contact

First Name*:

Last Name*:

Phone Number*:

Cell Phone Number:

Your Email*:

Postal Code*:

Address*:

City*:

Province*:

References

Please provide 2 references: (Ideally employers, teachers, or colleagues)

Reference 1

First Name*:

Last Name*:

Contact Number*:

Email Address*:

Reference 2

First Name*:

Last Name*:

Contact Number*:

Email Address*:

Interest

Please explain why you would like to take a laser training course*:

What are you hoping to achieve with this training program?*

Please identify your personal strengths and weaknesses*:

General Information

Please provide the following:

Copy of your degree or diploma of your highest level of education*:

Criminal record check*:

Up-to-date CV*:

Immunization record*:

Statement of Authenticity*:

We will be contacting you in 2 weeks upon receipt of this application for an interview.