Form Bah - Barber And Hairdresser Application - Alaska Department Of Community And Economic Development Page 2
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7BAH
Department of Community and Economic Development
FOR OFFICE USE ONLY
Division of Occupational Licensing
Board of Barbers and Hairdressers
333 Willoughby, 9th Floor
P.O. Box 110806, Juneau, Alaska 99811-0806
(907) 465-2547
E-mail: license@dced.state.ak.us
APPLICATION FOR ESTHETICIAN (SKIN CARE) LICENSE
I hereby apply for a license in the State of Alaska by:
Waiver of Examination
Examination
Temporary Permit or Temporary License Requested:
Yes
No
Total Due: $ 50 Application Fee
$50 Temporary Permit/License Fee
$135 Initial License Fee
$55 Examination Fee
$20.00 Written
$35.00 Practical
ESTHETICS — As defined by AS 08.13.220(4), means the use of the hands, appliances, cosmetic preparations, antiseptics, or
lotions in massaging, cleansing, stimulating, or similar work on the scalp, face, or neck, including skin care, make-up, and
temporary removal of superfluous hair, for cosmetic purposes for a fee. An esthetician license does not allow the licensee
to practice as a hairdresser.
Name:
Telephone: (Home)
(Work)
Mailing Address:
Address
City
State
ZIP Code
Social Security Number:
Sex
M
F Date of Birth:
(Required by AS 08.01.060)
Name of Esthetician School:
School
Address
Dates Attended
Total Hours
School
Address
Dates Attended
Total Hours
Licensing information: (List all states where you hold/have held a license.)
State
License #
Category
Date Issued
Expiration Date
State
License #
Category
Date Issued
Expiration Date
State
License #
Category
Date Issued
Expiration Date
I hereby certify that the information contained in this application is true and correct to the best of my knowledge.
Signature of Applicant
Subscribed and sworn before me this
day of
,
,
SEAL
Notary Public
My Commission Expires:
08-4193a (Rev. 2/01)
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