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.