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Personal Information Name Address Email Social Security Phone Number Licensure License Expiration Date Name of Barber School Experience Agree and Submit I certify that the statements and information furnished by me in this application are true and correct. I understand that omitted, false or misstated statements on this application are grounds for refusal to hire, or dismissal, at any time the Company becomes aware of the omitted, falsified, or misstated information. I agree and hereby authorize Barber Surgeons to conduct an investigation of all statements contained in this application, and any company form completed by me for employment as may be necessary in arriving at an employment decision. I authorize all previous employers or other persons who have knowledge of my records, to release such information to Barber Surgeons, their agents, or me.