Fillable Form 38924 - Application For Cosmetology Salon License (Page 2 of 2) in pdf

SALON REQUIREMENTS

Number of work stations ______________

Eight (8) combs

Three (3) brushes

Operable sterilizers on premises - must have

at least one (1) wet and one (1) dry

Effective disinfectant

Operable sterilizers at each work station - must have

at least one (1) wet and one (1) dry

10.

One (1) cabinet or drawer for storage of clean towels

Hot and cold running water

11.

One (1) covered hamper for storage of soiled towels

Shampoo bowl or shampoo sink

12.

Twelve (12) towels

Number of covered waste receptacles -

one (1) for every two (2) work stations

Salon shall have sanitary requirements and all licenses posted and a sign visible at the main public entrance of the salon, stating the name of the

establishment and that the establishment is a cosmetology salon.

A change in salon ownership or location will require the filing of a new salon application.

Any person providing cosmetology services in the salon must possess a valid cosmetologist license issued by the Board of Cosmetology Examiners.

Cosmetology salon leasing or subleasing to an esthetician under IC 25-8-12.6-7, shall maintain a separate room for such practice which is used exclusively

for esthetics services and comply with Rule 2, sanitary requirements for estheticians as established by the board.

Cosmetology salons providing electrology shall maintain a separate room for such practice which is used exclusively for electrology services, and comply

with 820 IAC 3-1-12, sanitary requirements for electrologists as established by the board.

If salon is owned by a corporation or partnership, list the name, title and address of the officers of the corporation or partners of the partnership.

NAME

TITLE

ADDRESS

AFFIDAVIT

I will operate establishment in compliance with the rules governing the sanitary requirements of cosmetology salons as required by the State Board of

Cosmetology Examiners, and ensure that all employees comply with all requirements. (If cosmetology salon is owned by a corporation or partnership, this

application must be signed by an officer of the corporation or a partner of the partnership.)

The cosmetology salon will be under the personal supervision of ______________________________________________________________________

License number _________________________, expiring _____________________________________________, who has at least six (6) months active

experience as a cosmetologist, under IC 25-8-9, before the application was submitted.

Have you ever committed an act for which you could be disciplined under IC 25-8-14?

If the answer is Yes, please describe the act on a separate sheet of paper

and attach to this application.

Yes

Signature of applicant / corporate officer / partner

I swear of affirm that the above statements are true and correct to the best of

my knowledge and belief.

NOTARY CERTIFICATE