PERSONAL INFORMATION
[A]
Name
First Name
Last Name
Current Residence
City
State
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
waii
Idaho
Illinois
Indiana
lowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Onlin
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Do you Own or Rent?
How long at Current Residence?
How long at Current Residence?
1-5 Years
6-10 Years
11-15 Years
16-20 Years
21-25 Years
26-30 Years
30+
Month
1 Month
2 Month
3 Month
4 Month
5 Month
6 Month
7 Month
8 Month
9 Month
10 Month
11 Month
12 Month
How may we reach you?
Home Phone
Work Phone
Cell Phone
Best time of day to call ?
Email Address
More about you...
Date of Birth
Marital Status
Single
Married
Separated
Widowed
Divorced
If married:
Spouse's First Name
Spouse's Last Name
Occupation
Ages?
Please explain any physical limitations or conditions which may preclude certain types of activities
Enter explanation here...
Citizenship
If not, of what country
EDUCATION
High School
College or University
Graduate School
Please list any addition Licenses or Certifications obtained...
Are there any other Special Skills or Training you wish to share with us?
[ C ]
EMPLOYMENT PROFILE
- List your three most recent positions, with your current positions first.
- Put an asterisk (*) next to any company names you do not want us to contact.
- Indicate "A" for Applicant, "S" for Spouse.
Employment 1
Employer
City/State
Position/Title
From
To
Annual Income
Employment 2
Employer
City/State
Position/Title
From
To
Annual Income
Employment 3
Employer
City/State
Position/Title
From
To
- List your three most recent positions, with your current positions first.
- Put an asterisk (*) next to any company names you do not want us to contact.
- Indicate "A" for Applicant, "S" for Spouse.
Annual Income
[ D]
What are your special interests or hobbies?
How long have you considered owning your own business, and why?
Why are you interested in owning a Gecko Hospitality franchise?
Briefly describe what you view as the qualifications, traits, and skills you have that would enable you to successfully own and operate a Gecko Hospitality franchise.
What career and/or financial goals have you set for yourself and your family?
Will the business be owned and operated by you alone, or with one or more business partners? Please explain.
Will you be responsible for the day-to-day operations of the business? If not, who will?
How will you finance any additional capital needs?
What area or territory are you applying for?
Would you consider any other areas? If so, where?
How soon could you be ready to open a Gecko Hospitality unit?
[ E]
REFERENCES
REFERENCES
Employment 1
1
Name
Street Address
City
State
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
waii
Idaho
Illinois
Indiana
lowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Onlin
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Telephone
Employment 2
2
Name
Street Address
City
State
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
waii
Idaho
Illinois
Indiana
lowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Onlin
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Telephone
Employment 3
3
Name
Street Address
City
State
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
waii
Idaho
Illinois
Indiana
lowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Onlin
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Telephone
- Please list three Bank or Other Financial References.
- Do not list former employers or relatives.
1
Name
Street Address
City
State
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
waii
Idaho
Illinois
Indiana
lowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Onlin
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Telephone
2
Name
Street Address
City
State
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
waii
Idaho
Illinois
Indiana
lowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Onlin
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Telephone
3
Name
Street Address
City
State
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
waii
Idaho
Illinois
Indiana
lowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Onlin
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Telephone
If Yes, please explain:
If Yes, please explain:
If Yes, please explain:
If Yes, please explain:
[ F]
CONFIDENTIAL FINANCIAL STATEMENT
ASSETS
Cash On Hand and In Banks
Marketable Securities, In Ev
Non-Marketable Securities,
Automobiles and other Pers
Cash Value Life Insurance,
Other Assets - Itemize:
Enter name, then value In Ev
Enter name, then value In Ev
Enter name, then value In Ev
Enter name, then value In Ev
Enter name, then value In Ev
TOTAL ASSETS:
TOTAL ASSETS:
LIABILITIES
TOTAL LIABILITIES
NET WORTH:
TOTAL LIABILITIES & NET WORTH:
TOTAL LIABILITIES & NET WORTH:
I authorize you to make investigations of my credit, character and ability, and to contact anyone, whether listed above or not, including former employers, in order to obtain personal information about me. I release all such persons from any liability or damages that may be incurred as a result of furnishing such information. I also certify that all information in this application is true and complete.
Signature
Date
Spouse's Signature
Date
©2015 Gecko Development Corporation
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