Confidential Questionnaire

 

Click here to download a printable version

* required information

PERSONAL INFORMATION
*Date: (MM/DD/YY)
*Name (or Names if more than one principle):
*Email Address: 
*Home Address: 
*City:

*ST:

*Zip:
*Home Phone:      *Office Phone:      *Fax: 
*Best time to reach you by telephone: 
*Date of Birth: (MM/DD/YY) 

*Marital Status: 

*Number of Dependents: 

*Do you own or rent your home?  *Years at present address: 
*Education: (highest level attained) 
*Spouse's name and occupation: 

 

EMPLOYMENT INFORMATION
Employment During the Past Ten Years- list present or last job first
*Employer:
*Duties:
*Salary:
*Employment Dates: From:    to 
Employer:
Duties:
Salary:
Employment Dates: From:    to 
Employer:
Duties:
Salary:
Employment Dates: From:    to 
Other pertinent business information:

 

GENERAL INFORMATION
*How did you become interested in our franchise?
*Do you own or have you ever been affiliated with any franchise? 

If yes, describe:
*Do you currently have a source of financing or liquid assets for the required investment? 
Would you expect to devote your full time to this business? 
         If not, what percentage?  %
Is your spouse in accord with your purchasing a franchise? 
To what degree will he/she be involved in the business? 
Describe your current fitness level:
*What experience do you have related to working with children?
*Do you enjoy pre-school age children? 
Hobbies:
Additional information that may be helpful:

The purpose of this personal profile is for general information only and is in no way binding upon either you or our Company.  It is understood, however, that you supply this information to the best of your knowledge and ability and that we can rely on this fact.

*Signature:
by typing your name in the above box, you are electronically signing this form.
*Date: (MM/DD/YY)

 

© Champion Child, Inc. 2006