A. Name, residence address and telephone number;

B. Social security number and drivers license number, if any;

C. Applicant’s weight, height, color of hair and eyes, and date of birth;

D. Two prints of a passport size photograph of applicant taken within thirty days prior to the date of application;

E. Certificate from a medical doctor stating that the applicant has, within thirty days immediately prior to the filing of the application, been examined and found to be free from any contagious or communicable disease;

F. Written evidence that the applicant is at least eighteen years of age;

G. Business, occupation or employment history of the applicant for the three years immediately preceding the date of application;

H. The name and address of the establishment where the applicant is to be employed, if any, and the name of the owner or the operator of same. Any applicant granted a permit pursuant to this section must report any change of massage establishment employment within five days of said change;

I. The name and address of the recognized school of massage attended, and a copy of the diploma or certificate of graduation from a recognized school of massage showing that such applicant or permittee has completed at least two hundred class hours or one hundred class hours and one hundred actual massage hours supervised by persons authorized or certified to provide instruction and/or supervision of massage;

J. All criminal convictions;

K. Whether the applicant is required to register under the provisions of Section 290 of the California Penal Code;

L. Whether the applicant, including any officer, director or any shareholder holding more than five percent of the stock of the corporate applicant or any partner, including limited partners, or any partnership applicant, corporation or partnership, or a former employer of the applicant while so employed, or a building in which the applicant was so employed or a business conducted, was ever subject to an abatement proceeding under Sections 11225 – 11235 of the California Penal Code or any similar provisions of law in a jurisdiction outside the state. (Ord. 1002 § 1 (part), 1984: prior code § 4911)