Because of the large volume of inquiries we receive, only those individuals who
complete this Confidential Franchise Application Form will be sent our comprehensive
franchise package.
|
Contact Information:
|
|
* Information required to process form.
|
|
|
*
First Name: *
Last Name:
|
|
|
|
|
Applicant:
|
|
|
*
Home Phone:
|
|
|
Spouse:
|
|
|
Business Phone:
|
|
|
*
Address:
|
|
|
Cell Phone:
|
|
|
|
* E-Mail: |
|
|
|
Best Time to Call: |
|
|
* City: |
|
|
Please contact me by: |
|
|
* Country: |
|
|
|
* State/Province: |
|
|
|
* Zip/Postal Code: |
|
|
|
|
|
How did you hear about us? (Please select from following list)
|
|
|
|
What is your interest level? |
|
|
|
|
|
|
Personal Information: |
|
Your Health: |
|
|
Please Explain: |
|
|
Social Security Number: |
|
|
Number of Dependents and Ages: |
|
|
High School Education Years: |
High School Degrees: |
|
College Education: |
College Degrees: |
|
|
|
Employment/Business History: |
|
Current Employer/Business: |
Position: |
|
Address: |
|
|
City: |
|
|
State/Province:
|
|
|
Zip/Postal Code:
|
|
|
Business Phone: |
|
|
Fax: |
|
|
Can You be Called at This Business Address Location? |
|
|
|
|
How Long Have You Been With Your Current/Prior Employer/Business? |
|
|
|
|
|
|
ComForcare Senior Services Franchise Specific Questions: |
|
Have you ever owned your own Business? |
|
|
|
|
|
If Yes, What type/how long? |
|
|
|
|
What Personal or business experiences do you have that would assist you in running your own business? |
|
|
|
|
Why do you feel you would be good at owning and operating a ComForcare franchised office? |
|
|
|
|
Would you be available to operate the business on a full time basis? |
|
|
|
|
|
If No, Who would run the business? |
|
|
|
|
If Applicable, describe the business and personal background of the alternate manager of the business. |
|
|
|
|
If you operated and managed the business yourself, how many hours per week would you be willing to invest into your own business the first year to insure the business gets the proper start that it needs? |
|
|
|
|
If you did not operate and manage the business, how many hours per week would you make available for assistance, secondary or backup processing and consultation? |
|
|
|
|
In what city or county and state/provice would you like to open and operate your ComForcare Senior Services business? |
|
First Choice: |
|
|
Second Choice: |
|
|
By what date would you like to begin operating your new business? |
|
|
|
|
How much capital do you currently have available to invest in a franchise? |
|
|
|
|
Have You Considered Other Types of Franchise? |
|
|
|
|
|
If Yes, What type? |
|
|
|
|
Have you Ever Cared For an Elderly Person? |
|
|
|
|
|
If yes, describe the situation |
|
|
|
|
ComForcare Senior Services invites you to attend a Free Corporate Visit. Please reserve for me to attend. Visits are scheduled monthly and I would tentatively like to attend sometime within the next |
|
|
|
Why did you investigate the elderly market for your own business? |
|
|
|
|
|
|
Additional Personal/Business History: |
|
Have you Declared Bankruptcy in the last 15 years? |
|
|
|
|
|
If yes, describe the situation |
|
|
|
|
Have You Ever Been Convicted of a Crime? |
|
|
|
|
|
If yes, describe the situation |
|
|
|
|
Do You Have any pending litigations against you? |
|
|
|
|
|
If yes, describe the situation |
|
|
|
|
Any Litigations Pending Against Others? |
|
|
|
|
|
If yes, describe the situation |
|
|
|
|
|
Personal References, excluding family or subordinates:
(References will not be called until after a discussion with you) |
|
First Reference: |
|
| Name: |
|
Years known: |
|
| Relationship: |
|
Phone Number: |
|
| Address: |
|
| |
|
Second Reference: |
|
| Name: |
|
Years known: |
|
| Relationship: |
|
Phone Number: |
|
| Address: |
|
| |
|
Third Reference: |
|
| Name: |
|
Years known: |
|
| Relationship: |
|
Phone Number: |
|
| Address: |
|
| |
|
I understand that the acceptance of this Franchise Application by ComForcare Senior Services
or any of its affiliates does not constitute the grant of a franchise. I understand that
ComForcare Senior Services grants franchises only by executing written franchise agreements.
By submitting this application, I authorize ComForcare Senior Services and its assigns to start
an investigative consumer report (including information regarding my character, general
reputation, personal characteristics and mode of living) and credit investigations based on the
information voluntarily provided by me and warrant that all information provided is true and
accurate. I understand that I have a right to request that ComForcare Senior Services make a
complete and accurate disclosure of the nature and scope of such investigation.
ComForcare Senior Services may obtain my credit report in connection with this application.
This is my authorization to credit reporting agencies, bank(s), creditors, and suppliers to
release to ComForcare Senior Services, and to ComForcare Senior Services to release to such
parties, all information requested regarding my depository, loan or other credit information
including, without limitation, financial information, by telephone or in writing as part of
the normal credit evaluation process. I release my bank(s), creditors, suppliers and
ComForcare Senior Services from all liability with respect to the release of any such requested
information. Authorization is granted to use photo or fax copies of my signature to obtain
information. If I am requesting that ComForcare Senior Services make a credit determination
based on my credit worthiness combined with any co-applicants, I authorize
ComForcare Senior Services to discuss any derogatory credit items with such co-applicants.
I understand that ComForcare Senior Services may at any time, require that I sign an updated
application or provide updated information.
|
| I accept the above terms* |
|
If you do not accept the above terms,
your application will not be fully processed.
|
| |
|
Privacy Statement: ComForcare Senior Services will not sell or rent your non-public information to anyone. |
|
|
|
