Careers Franchising, Inc., 6501 Congress Avenue, Suite 200, Boca Raton, FL t: (561) f: (561) toll free: CAREERS

Transcription

1 Careers Franchising, Inc, 6501 Congress Avenue, Suite 200, Boca Raton, FL 33487

2 QUALIFICATION QUESTIONNAIRE To be on your way to owning your very own CareersUSA franchise, simply complete our Confidential Qualification Questionnaire You may choose to print this form and fax or mail to our Franchise Department, or you may complete our online application Once we receive your information, we will begin our review immediately Please rest assured that your information will be kept strictly confidential at all times Please fax or mail the completed form to our Franchising Department Fax: Mail: CareersUSA, Inc Attn: Trudy Feldman, Executive Vice President, Franchise Development 6501 Congress Ave, Suite 200 Boca Raton, FL Careers Franchising, Inc, 6501 Congress Avenue, Suite 200, Boca Raton, FL 33487

3 CONTACT INFORMATION first name m i last name street address city state country day phone evening phone fax social security number driver's license number when is the most convenient time to call? PERSONAL/FAMILY Have you ever been convicted of a crime other than a traffic violation? if "yes," please explain Are you a US citizen? if "no," state country of citizenship marital status? Single / Married / Separated / Divorced / Widowed Spouse's Name S S # EDUCATION & ACTIVITIES School Major Yrs Compl YR Graduated Degree Have you ever received special training in management? if "yes," please describe: Have you ever received special training in sales? if "yes," please describe: Careers Franchising, Inc, 6501 Congress Avenue, Suite 200, Boca Raton, FL 33487

4 BUSINESS/PROFESSIONAL/CIVIC ORGANIZATIONS Business Professional Civic MILITARY Have you ever served in the US Armed Forces? If yes, which Branch? Dates of duty From To Rank at discharge? BUSINESS OR SELF-EMPLOYMENT HISTORY 1 Date Started Date Finished Company Name Department Street Address City State Zip Telephone Supervisor Job Title Annual Salary May we contact? Job Title Description of Responsibilities Reason for Leaving 2 Date Started Date Finished Company Name Department Street Address City State Zip Telephone Supervisor Job Title Annual Salary May we contact? Job Title Description of Responsibilities Reason for Leaving 3 Date Started Date Finished Company Name Department Street Address City State Zip Telephone Supervisor Job Title Annual Salary May we contact? Job Title Description of Responsibilities Reason for Leaving Careers Franchising, Inc, 6501 Congress Avenue, Suite 200, Boca Raton, FL 33487

5 FINANCIAL DATA Assets Available Cash in Bank: Stocks and Bonds: IRAs and Insurance: Real Estate: Automobile(s): Personal Property: Other Assets: Account 1 Value Account 2 Value Account 3 Value Stock Value Bond Value 401(k) Vested Value Life Insurance (Cash Surrender Value) Property Value Property Value Auto Net Value Auto Net Value Liabilities Notes Payable to Bank: Loan 1 Loan 2 Mortgage 1 Mortgage 2 Revolving Accounts: Payment 1 Payment 2 Payment 3 Outstanding Taxes: Child Support/Alimony: Other Liabilities: Bank Notes Payable to Bank: Loan 1 Loan 2 Mortgage 1 Mortgage 2 Revolving Accounts: Payment 1 Payment 2 Payment 3 Outstanding Taxes: Child Support/Alimony: Other Liabilities: Careers Franchising, Inc, 6501 Congress Avenue, Suite 200, Boca Raton, FL 33487

6 Other Financial Information Do you have an established source/backer of funding? If yes, please explain Have you ever filed for bankruptcy? If yes, please explain Have you ever owned/partnered a business? If yes, please explain REFERENCES Name Relationship Address City, State Zip Phone Years Known >1, 1-3, 4-6, 7-10, or 10+ May we contact? Name Relationship Address City, State Zip Phone Years Known >1, 1-3, 4-6, 7-10, or 10+ May we contact? Name Relationship Address City, State Zip Phone Years Known >1, 1-3, 4-6, 7-10, or 10+ May we contact? GENERAL List your location preferences (in order): Why would you like to be in business for yourself? If your application is approved, when could you begin training in our Headquarters in Boca Raton, Florida? How did you hear about Careers USA? Please list any other franchise opportunities you currently are investigating: How will you participate in the operation of this franchise? Careers Franchising, Inc, 6501 Congress Avenue, Suite 200, Boca Raton, FL 33487

7 ADDITIONAL INFORMATION If you would like to provide us with any additional information, feel free to do so here I am certifying the information set forth in this application and my personal statements to be true as of this date I further certify that there is no judgment against me, no lien unsatisfied upon my property except as shown and no suit pending against me in any court This application does not obligate either party as a result of its submission PRINT NAME SIGNATURE DATE Careers Franchising, Inc, 6501 Congress Avenue, Suite 200, Boca Raton, FL 33487