Mesa, AZ · Maricopa County
Massage and Bodywork Establishment Employee & Contractor Log
Massage and bodywork establishment licensees use this form to report employees and contractors to Mesa for new or renewal applications and staffing changes.
What this form is
This log lists the employees and independent contractors who provide massage therapy or bodywork at a Mesa establishment. Submit it with a new or renewal establishment application, or use it to report individuals being added or removed; staffing changes must be reported within ten calendar days. The form asks for business and license details, worker names, positions, hire dates, massage duties, and status.
Who needs it
Mesa massage and bodywork establishment applicants and licensees use this form to list workers or report staffing changes.
How to submit it
Submit the completed form to Business Services – Licensing/MS 1190, PO Box 1466, Mesa, AZ 85211-1466. The form also lists [email protected], phone 480-644-2316, and fax 480-644-3999.
About notarization
This document is signed and dated without a notary; attach a copy of each massage therapist’s Arizona Massage Therapy License, with no notarized or sworn attachment specified.
How to submit this form
- 1
Download The Log
Download the Employee & Contractor Log PDF.
- 2
Complete The Form
Enter the business and license details and list the applicable employees or contractors.
- 3
Gather Attachments
Include a copy of the Arizona Massage Therapy License for each therapist who will perform massage.
- 4
Submit To Mesa
Send the completed log and required license copies to the Licensing office using the address, email, or fax listed on the form.
Frequently asked questions
- Do I need a notary for the Massage and Bodywork Establishment Employee & Contractor Log?
- No. The form is signed and dated without a notary. Attach a copy of each massage therapist’s Arizona Massage Therapy License.
- How do I submit the Employee & Contractor Log?
- Send it to Business Services – Licensing/MS 1190, PO Box 1466, Mesa, AZ 85211-1466. The form also lists an email address and fax number.
- When should I file this log?
- Submit it with a new or renewal Massage or Bodywork Establishment application. Existing licensees use it to report staffing changes, which must be reported within ten calendar days.
- What information does the log request?
- It asks for the business name, location, license or application number, and each worker’s name, position, hire date, massage duties, and employment status.
Need something notarized?
This Massage and Bodywork Establishment Employee & Contractor Log doesn’t need a notary — but if you have another Mesa form that does, a commissioned online notary can help.