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3 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR – TATTOO & BODY PIERCING ARTIST <br />MUNICIPAL CODE SECTIONS – 13-125 – 13-152 <br />II. PERSONAL DATA (Continued) <br />Q.Employment History (Continued) <br />Company 3: <br />Dates of Employment: <br />Address: <br />City, State, ZIP: <br />Supervisor: <br />Telephone Number: <br />Company 4: <br />Dates of Employment: <br />Address: <br />City, State, ZIP: <br />Supervisor: <br />Telephone Number: <br />(Attach additional sheets if necessary) <br />IV.INCLUDE WITH APPLICATION: <br />A.Written proof applicant is not a minor. <br />B.Statement from medical doctor certifying applicant has been examined and found free <br />of communicable disease within thirty (30) days of application date. <br />C.Copy of High School Diploma, GED, or degree. <br />D.List of all training and education pursuant to work and services to be provided, including <br />name and address of institution attended, dates of attendance, degrees or certifications <br />earned, and credit hours completed. <br />E.Official transcript showing training and education, including practical theory, for the <br />following: <br />1.Laws and rules <br />2.Bacteriology <br />3.Sanitation and sterilization <br />4.Anatomy and physiology <br />5.Endocrinology <br />6.Equipment/supplies <br />7.Basic color theory/pigments <br />8.Structure, dynamics, and diseases of the skin and hair <br />9.Anatomy for piercers