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5 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />215 S. Dr. Martin Luther King Jr. Blvd. • Suite 500 <br />South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <br /> <br />LICENSE APPLICATION FOR – TATTOO & BODY PIERCING ESTABLISHMENT <br />MUNICIPAL CODE SECTION – 13-125 – 13-152 <br />IV. PERSONAL DATA (Continued) <br />O. Employment History (Continued) <br />Company 3: <br />Dates of Employment: <br />Address: <br />City, State, ZIP: <br />Supervisor: <br />Telephone Number: <br /> <br />Company 4: <br />Dates of Employment: <br />Address: <br />City, State, ZIP: <br />Supervisor: <br />Telephone Number: <br /> <br />(Attach additional sheets if necessary) <br />V. 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 <br />the 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