Step 1 of 5 - Personal 20% Name* First Last Personal Current Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Personal Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Personal PhoneLast 4 of SSN# Business PhoneCosemetology License # Federal Tax EIN Do you have articles of incorporation? Not at this time Yes I do In the near future Educational History High School College / University Graduate School Vocational / Technical School Employer (Current / Previous) Details (Booth Amount, Address, Phone, etc.) Provide up to 3 References (Name, Phone, Email)Can we contact your last employer?YesNoLet's talk firstName of last salon owner or supervisor? Booth rent / commission / hourly pay Thank you for seeking tenancy with Urban One Salons. All qualified applicants over 18 years old are considered regardless of race, creed, color, sex, religion, national origin, age, disability and any other reason protected by law. Type of suite applying for? Single Double Larger Will anyone work in the suite with you? Yes No Pending If yes, name of other person working in suite Desired date to begin leaseMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Please truthfully answer the next five questions about any past felony charges, if applicable...Have you been convicted of or plead guilty to any criminal felony offense?YesNoHave you been released from confinement following a conviction for any criminal felony offenses?YesNoAre you presently charged with any felony violatoins of law?YesNoPlease list services you provide Emergency Contacts Name / Phone / Relationship) I hereby state that the information given by me in this application is true in all respects. I agree that if I am accepted for leasing and the information is found to be false in any respect, I will be subject to dismissal without notice at any time. I hereby authorize my former employers or salon owners to release information pertaining to my work record, my work habits and my work performance while in their employ or salon. I will read and abide by the rules outlined in any procedures manual that I may receive. (Note to all applicants: Please submit a copy of your current identification with your leasing application, such as a valid driver’s license, state id, etc.)Signature (sign with mouse or finger)EmailThis field is for validation purposes and should be left unchanged.
