Form Bah - Barber And Hairdresser Application - Alaska Department Of Community And Economic Development Page 4
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7State of Alaska
Board of Barbers and Hairdressers
VERIFICATION OF WORK EXPERIENCE
Applicant: complete the top section and mail to your former employer if you need to receive credit for working experience when
applying for licensure as a hairdresser or barber by waiver of examination (see 12 AAC 09.095(C)(D)). If you were the owner
of your own shop, an individual who has direct personal knowledge of your work experience hours while you were
self-employed may sign this document certifying your work experience as a hairdresser or barber.
Please have the person verifying your work experience mail this form to:
Department of Community and Economic Development
Division of Occupational Licensing
Board of Barbers and Hairdressers
333 Willoughby, 9th Floor
P.O. Box 110806
Juneau, Alaska 99811-0806
Applicant Signature:
Printed Name:
Address:
PLEASE DO NOT DETACH. The information below must be completed by a former employer. Please mail directly to the
State of Alaska
(Applicant's Name)
was employed at the
(Name of Shop)
Mailing Address:
Dates of
From
To
Employment:
Month
Day
Year
Month
Day
Year
From
To
Month
Day
Year
Month
Day
Year
Average Number of Hours Worked Per Week
Position as:
Practitioner of barbering
Practitioner of hairdressing
Other
How are/were you associated with the applicant?
I hereby certify that the above information is true and correct to the best of my knowledge.
Signature
SUBSCRIBED AND SWORN to me this
day of
,
.
Notary Public
SEAL
My Commission Expires:
08-4193c (Rev. 2/01)
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