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Permit Application for Person(s) Engaged in Off-Site Massage Therapy

Personal Information

Apt., Suite, etc.

Applicant
Two (2) Previous Addresses Prior to Current Address

Apt., Suite, etc.

Apt., Suite, etc.

Physical Description

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.
Agreements

Information message

Please read the municipal code: Division 3 Massage Therapist License
Once you have finished, initial the Municipal Code Agreement field below. 

I Agree (initial)

By initialing, you agree that you have read and understood the municipal code provided above.

By signing and submitting this form, I certify that the information provided is true and accurate to the best of my knowledge.

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City of Moore Seal

VANESSA KEMP
City Clerk
[email protected]

CITY CLERK`S OFFICE
City Hall
301 N. Broadway
Moore, OK 73160
405-793-5020