State Form 49529 - Application For Cosmetology Continuing Education Instructor - 2000
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2INDIANA PROFESSIONAL LICENSING AGENCY
APPLICATION FOR COSMETOLOGY
302 W. WASHINGTON STREET, ROOM E034
CONTINUING EDUCATION INSTRUCTOR
INDIANAPOLIS, IN 46204
State Form 49529 (R / 10-00)
(317) 232-2980
INSTRUCTIONS: This application must be completed by the instructor and filed by the approved educator. Attach a resume.
Name of instructor
Address (number and street, city, state, ZIP code)
Name of continuing education educator
QUALIFICATIONS
Instructors must possess at least one (1) of the following minimum qualifications. Please indicate all that apply.
1) An instructor for a cosmetology school licensed under IC 25-8-5
Name of school: _____________________________________________________________________________________________________
Dates of experience: _________________________________________________________________________________________________
2) Possession of a Bachelor's Degree from a college or university in a related field to that in which the person is to teach or a comparable degree from
a school of a foreign country. (ATTACH TRANSCRIPT)
List degree(s): _________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
3) Five (5) years of full-time experience in a profession, trade, or technical occupation relevant to cosmetology, manicuring, esthetics, or electrology.
Indicate work experience below.
Name of present employer
Employer address
Date employed:
Brief job description:
From:
To:
Name of past employer
Employer address
Date employed:
Brief job description:
From:
To:
Name of past employer
Employer address
Date employed:
Brief job description:
From:
To:
Name of past employer
Employer address
Date employed:
Brief job description:
From:
To:
Name of past employer
Employer address
Date employed:
Brief job description:
From:
To:
(over)
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