APPLICATION FORM
Date:
The following information is the basis for my franchise application. The submission of the application does not obligate Lamppost Pizza or myself in any way or manner.
(Please print or type)
PERSONAL INFORMATION
NAME / SOCIAL SECURITY NO. / / /
Last / First / Middle
ADDRESS:
Street / City / State / Zip Code
Residence Telephone / ( ) / BEST TIME TO CALL: / From: / To:
Business Telephone / ( ) / From: / To:
DATE OF BIRTH: / MARITAL STATUS: / NO. OF DEPENDENTS:
SPOUSE'S NAME: / SPOUSE'S OCCUPATION:
PERSONAL HISTORY:
ARE YOU A CITIZEN OF THE USA? / Yes / No / IF NO, PLEASE GIVE PLACE OF PERMANENT
RESIDENCE AND YOUR IMMIGRATION STATUS IN THE USA:
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR (other than a minor traffic violation)?
Yes / No / IF YES, PLEASE STATE DETAILS:
DO YOU HAVE ANY FELONY CHARGES PENDING, BEING APPEALED, OR ARE YOU UNDER INDICTMENT?
Yes / No / IF YES, PLEASE STATE DETAILS:
HAVE YOU EVER BEEN ADJUDICATED BANKRUPT? / Yes / No / IF YES, PLEASE STATE DETAILS:
PERSONAL REFERENCES: / (NAME THREE PERSONS WHO HAVE KNOWN YOU AT LEAST TWO
YEARS - NOT FORMER EMPLOYEES OR RELATIVES)
NAME / ADDRESS / POSITION / TELEPHONE
1. / ( )
2. / ( )
3. / ( )
BUSINESS INTEREST:
HOW OR WHY DID YOU BECOME INTERESTED IN LAMPPOST PIZZA?
WILL YOU HAVE A BUSINESS PARTNER(S)? / Yes / No / IF YES, PLEASE GIVE NAME OF EACH
PARTNER
Note: Separate application and financial statements are required of each partner.
WHAT PERCENT OF THE EQUITY OF THE RESTAURANT WILL YOU OWN? / %
HOW WILL YOU FINANCE THIS BUSINESS VENTURE? / CASH $ / LOAN $
BUSINESS EXPERIENCE: (Give present or last position first. If additional space needed attach separate sheet.)
MAY WE CONTACT YOUR PRESENT EMPLOYER? / YES / NO
COMPANY: / ADDRESS:
TYPE OF BUSINESS: / EMPLOYED FROM: / TO:
POSITION: / ANNUAL SALARY:
SUPERVISOR: / TELEPHONE: / ( )
DESCRIBE DUTIES, RESPONSIBILITIES AND NUMBER OF EMPLOYEES SUPERVISED:
COMPANY: / ADDRESS:
TYPE OF BUSINESS: / EMPLOYED FROM: / TO:
POSITION: / ANNUAL SALARY:
SUPERVISOR: / TELEPHONE: / ( )
DESCRIBE DUTIES, RESPONSIBILITIES AND NUMBER OF EMPLOYEES SUPERVISED:
LOCATION PREFERENCES:
FIRST CHOICE:
SECOND CHOICE:
OTHERS:
WILL YOU BE WILLING TO RELOCATE? / Yes / No / IF YES, PLEASE IDENTIFY WHERE: