LIMITED LICENSE APPLICATION
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Are you currently licensed in the State of Nevada? *

Licensed as a cosmetologist, aesthetician, nail technologist, or hair designer.
     
 
What is your Nevada license number? *

(C-XXXXX, M-XXXXX, A-XXXXX, HD-XXXXX)
 
Social Security Number (SSN) *

 
Date of Birth *

 
First Name *

 
Middle Name

 
Last Name *

 
Home Address *

 
Zip Code *

 
City *

 
Cell Phone *

 
Alternate Phone

 
Are you a US Citizen? *

     
 
What is your country of citizenship? *

 
Do you have authorization to work in the United States through a Work Visa, Resident Card, or other form of authorization? *

     
 
US Government Work Authorization Expiration Date *

 
What type of license do you have? *


 
What is your license number? *

 
What is the expiration date of your license? *

 
Upload a copy/photo of your current license. *

 
Do you know of the locations in which you will provide limited services? *

If no, you can add later by completing an online form or by emailing us at: licensing@nvcosmo.com.
     
 
Name of Location # 1 *

 
Date of Service # 1 *

 
Full Address # 1 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 2 *

 
Date of Service # 2

*

 
Full Address # 2 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 3 *

 
Date of Service # 3 *

 
Full Address # 3 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 4 *

 
Date of Service # 4

*

 
Full Address # 4 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 5 *

 
Date of Service # 5 *

 
Full Address # 5 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 6 *

 
Date of Service # 6 *

 
Full Address # 6 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 7 *

 
Date of Service # 7 *

 
Full Address # 7 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 8 *

 
Date of Service # 8 *

 
Full Address # 8 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 9 *

 
Date of Service # 9

*

 
Full Address # 9 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Name of Location # 10 *

 
Date of Service # 10 *

 
Full Address # 10 *

(Example: 1785 East Sahara Avenue, Suite 255, Las Vegas, 89104)
 
Do you need to provide more locations at this time?

     
 
Please upload a list of locations, along with applicable dates and address. *

You will be able to add more locations via an online form or by email us at: Licensing@nvcosmo.com.
 
Upload a photo of you to be put on the Limited License.

Photo must have a white background and be less than 90 days old. *

Photo must be the equivalent to a passport-type photo.  Display the head and shoulders with the face forward, towards the camera. 
 
Upload a copy/photo of a valid government-issued ID. *

Driver's License, State ID Card, Passport, Etc.
 
The Limited License is $100 and is valid for one (1) year after the date of issuance. *

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Thank you for applying for a Limited License.

Please allow us up to two (2) business days to review.
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We are sorry, only individuals with the authorization to work in the United States is permitted to obtain a Limited License.
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