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Date:
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| Name: |
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| Residential Address: |
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| City, State, Zip: |
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| How Long: |
Years |
| Home Phone: |
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| Email: |
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| Soc. Sec. #: |
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| Previous Address: |
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| City, State, Zip: |
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| Name of Fraternal, business, or
civic organizations you belong to: |
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| High School (Name): |
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| City/State: |
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| College (Name): |
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| Degree: |
Yes No Major |
| Graduate or Business School: |
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| Degree: |
Yes No |
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| Present business or occupation: |
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| Position: |
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| Bus. Phone: |
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| Type of Business: |
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| Address: |
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| City, State, Zip: |
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| How long in business: |
Years |
| Equity in business: |
Dollars |
| Current Salary: |
Dollars per Yr. |
| Avg. Income last 5 yrs: |
Dollars per Yr. |
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Previous
Business History
List company & city, employed from - to, position,
annual earnings, and supervisor name for each company: |
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Have you been bonded?:
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Yes No
Amount:
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Occupation of Spouse:
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Spouse Income per Yr:
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Business references, include name
and phone number, please provide a minimum of four:
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Financial
(Confidential) |
Your Assets
|
Cash in Banks:
(Checking and Savings) |
$
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Life Insurance:
Cash
Value |
$
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| Marketable Securities: |
$
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Real Estate:
HOME |
$
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| OFFICE |
$
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| Automobiles |
$
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Other Assets:
(list) |
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| Total Assets: |
$ |
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Your Liabilities |
| Loans & Note Payable: |
$ (List in
schedule below.)
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| Charge Accounts Payable: |
$
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| Loans Against Life Insurance: |
$
(List in schedule below.) |
| Real Estate Mortgages: |
$ (List in
schedule below.)
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Other Liabilities:
(list) |
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| Total Liabilities: |
$
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| Net Worth: |
$
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| How much capital can you initially invest in your own
business? $
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| Sources of additional capital
if needed: (show
amount & source) |
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I have additional income (i.e.
pensions, trusts, investments, ect.)
in the amount of
$ per year from
source(s)
. |
| What minimum annual income do
you require? $
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| Do you have any judgments or
liens outstanding? Yes No . If so, describe
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| Have you, or any company that
you had ownership in ever filed a petition for bankruptcy or made an
assignment for the benefit of creditors?
Yes No . |
| Have you any lawsuits pending
against you? Yes
No . If yes, describe |
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Schedules of Notes, Loans, & Mortgages Payable |
| Amount |
To Whom Payable |
Date of Maturity |
Secured |
Unsecured |
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I certify that this is a true
and complete statement of my financial position as of
,
20. |
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Signature: |
| Additional
Information |
In what city do you wish to
operate a AAA Employment franchise?
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Are you interested in other
cities?
Yes No
Which Ones? |
This is a career opportunity,
if accepted, how soon could
you start?
,
20.
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| Why would you like to own and
operate your own business? |
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| What are your business
strengths? |
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| What is the largest number of
people you have supervised?
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| What do you regard as your
business weaknesses? |
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| Have you ever been convicted
of a felony? Yes
No |
| Use the space below to ask
any questions you might have and offer additional comments on the
skills and talents you can bring to your own business. |
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| I would appreciate additional information
concerning a AAA Employment franchise. I authorize AAA
Employment, to make or request any investigation of my
background deemed necessary including, as applicable,
information as to character, general reputation and credit
history. My current employer will not be contacted without my
express content. I understand that AAA Employment will
furnish additional information as to the nature and scope of
any investigation if I request it in writing within a
reasonable time. Completing and submitting this form does not
obligate me to accept the program, nor does it obligate AAA
Employment to accept me. |
| Date: ,
20
Signature X |
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