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Human Hair

Hair Braiding Certification

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904-487-9254904-487-9254

904-487-9254 info@galacar.com

  

       
       
 

 

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Online Opportunities

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INDEPENDENT PROFILE STATUS  

Date:___________________________  Referred by:________________________________________ ID# ___________________________

Entry Opportunities:  Independent Online Rep  /  Independent Online Manager Rep

DESIRED OPPORTUNITY: _____________________________________ID#:_____________________ Your ID will be selected by the company.  Your ID# will not be changed without proper authorization.

NAME:    ______________________________________________  DATE OF BIRTH: ___________________________ AGE:________      

ADDRESS: ______________________________________________________________________________________________________

TELEPHONE: ___________________________EMAIL ADDRESS: ____________________________________CELL:_________________________

MAILING  ADDRESS:  ________________________________________________________________________________________________

City: _______________________________________ State:  ___________________________________ Zip code: __________________________

IN CASE OF AN EMERGENCY, NOTIFY: _____________________________________  TELEPHONE NUMBER : ______________________

Are you a Citizen of the USA? Yes or No  Alien Registration Number:________________________

Education

What is the highest school grade completed? _____________    Award: Diploma / Degree / GED :_____________________________ Certification:

 Are you a student? ________   Name of school attending: __________________________________, State:__________________

Employment History

Present Firm Name: _______________________________________State:______________, Zip: ____________          

Years employed: _______ Position: _______________________________Salary:__________________

REASON (S) FOR LEAVING: _________________________________________________________________________

Previous Firm Name: _______________________________________State:______________, Zip: ____________        

Years employed: _______ Position: _______________________________Salary:__________________

REASON (S) FOR LEAVING: _______________________________________________________________________

ADDITIONAL INFORMATION

FUTURE GOALS: _______________________________________________________________________________

Will this be a main source of earnings? Yes /No  Are there any illnesses that could inhibit performance? Yes /No

CONFIDENTIAL & OFFICE USE ONLY:

Recommendations:_____________________________________________________________________________________________

Receipt Date: __________________________________Receipt Time: _______________________________   

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