Step 1 of 11 9% Prospective Franchisee QuestionnaireName First Middle Last PhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CountyCurrent EmploymentCurrent Position/TitleTenure at Current PositionWhat experience have you had supervising and managing people?What experience have you had managing a retail establishment?Does becoming a Franchisee and operating your own business appeal to you? Yes No Why?To move forward in the application process, you will have to agree to a credit and criminal background check and a drug test. WILL YOU AGREE TO THIS? Yes No How did you hear about this opportunity?Do you have any objections to a dress code or certain appearance requirements? Yes No Will you agree to a Confidentiality Agreement and Non Compete Agreement? Yes No RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. A CONFIDENTIAL Prospective Franchisee ApplicationPersonal InformationName: Preferred NameSpouse’s NameAddress: Home PhoneBest Time to CallFrom Hours : Minutes AM PM AM/PM To Hours : Minutes AM PM AM/PM Work PhoneMay We Contact You At Work? Yes No If Yes, Best Time to CallFrom Hours : Minutes AM PM AM/PM To Hours : Minutes AM PM AM/PM Cell Phone: Have you previously completed a Family Fare Prospective Franchisee Application? Yes No If Yes, when? MM slash DD slash YYYY RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. To help ensure we have only the best team possible, we take the Franchisee selection process very seriously. Because of our potential close relationship, we encourage you to get to know us well. Please check us out thoroughly. We also want to take every appropriate opportunity to know you and positively consider your application. You can be assured that we will treat this personal information with respect and strict confidentiality.Please read the following statements carefully and acknowledge by signing your name and dating: “I certify that all the answers given in this application herein are true and complete to the best of my knowledge and are subject to confirmation by Family Fare and its agents. Family Fare may make such investigations and inquiries of my personal, educational, past employment, financial, or medical history, and other related matters as may be necessary in determining whether I can perform the functions required of a Franchisee. I hereby release past employers, schools, and all persons contacted from all liability in responding to inquiries in connection with my application. In the event I become a Franchisee, I understand that false or misleading information given in my application or interview(s) may result in termination of my Franchise agreement. I understand that I am required to abide by the Family Fare Franchise Agreement. In the event I am offered an opportunity to enter into a Franchisee agreement, I am willing to take a physical examination where physical condition may impact my performance as a Family Fare Franchisee. I understand that reasonable accommodations will be made where they do not create an undue hardship.”SignatureDate MM slash DD slash YYYY RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. INTERESTS Regardless of current and planned Family Fare locations, please list your geographic preferences in order of priority, including your present location with your reasons as to why you would like to live in those locations.First Location City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Reason For PreferenceSecond Location City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Reason For PreferenceThird Location City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Reason For PreferenceHow did you hear about and become interested in Family Fare?Why are you interested in being a Franchisee with Family Fare?Are you seeking a career change? Yes No IF YES, PLEASE EXPLAIN.RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. BACKGROUNDWhere have you lived previously from age 16 to present? Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State CountyReason For LeavingYour Age Then RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. WORK EXPERIENCE Your focus as a Family Fare Store Franchisee will be to not only sell products, but also provide the highest levels of service and support to your customers. Family Fare Franchisees are energetic, bright, hard-working entrepreneurs dedicated to making their stores a success. Tell us about your work experience. Please list all your work experience history, starting with your present or more recent employment. Do not refer to a resume in lieu of information on the application. The application must be complete.Present/Most Recent EmployerPhoneAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Type of Business/IndustrySupervisorPlease List Your Job Title(s), Responsibilities, and Number of Employees SupervisedStarting Date MM slash DD slash YYYY Final Date MM slash DD slash YYYY Reason for LeavingStarting Salary, Bonus, CommissionFinal Salary, Bonus CommissionPrevious Employers Employer NamePhoneAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Type of Business/IndustrySupervisorPlease List Your Job Title(s), Responsibilities, and Number of Employees SupervisedStarting Date MM slash DD slash YYYY Final Date MM slash DD slash YYYY Reason for LeavingStarting Salary, Bonus, CommissionFinal Salary, Bonus Commission RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. U.S. Military Service Yes No BranchRankPay StatusCities, States, and/or Countries StationedPlease describe your position and responsibilitiesStarting Date MM slash DD slash YYYY Discharge Date MM slash DD slash YYYY Did you receive an Honorable Discharge Yes No RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. EDUCATIONElementary SchoolElementary School NameElementary School Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ES Beginning MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberES Beginning Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925ES Ending MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberES Ending Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925Middle SchoolMiddle School NameMiddle School Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State MS Beginning MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberMS Beginning Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925MS Ending MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberMS Ending Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925High SchoolHigh School NameHigh School Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State HS Beginning MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberHS Beginning Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925HS Ending MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberHS Ending Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925Graduate? Yes No Grade AveragePlease enter a number from 0 to 6.Activities, Honors, Offices, etcRECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. Please list all trade, business, vocational and/or technical schools, junior colleges, colleges/universities, and graduate schools attended.Schools School NameSchool Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Beginning MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberBeginning Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925Ending MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberEnding Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925Graduate? Yes No Grade AveragePlease enter a number from 0 to 6.Degrees and MajorActivities, Honors, Offices, etc RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. PERSONAL BACKGROUND Family Fare relies on the entrepreneurial drive, leadership and energy of our Franchisees to independently manage their store operations. Knowing our success is directly related to the success of our Franchisees, we are committed to finding the best Franchisees possible.Social Security NumberDate of Birth MM slash DD slash YYYY Are you married? Yes No Spouse’s NameSpouse’s OccupationSpouse's PhoneNumber of DependentsPlease enter a number from 0 to 99.Please list dependents by name, age, and relationshipDo you own a home or rent? Own Rent What are your hobbies, activities, special interests?Would you please list your current membership and involvement in community, civic, social, church, and/or professional organizations?RECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details. Do you know any current or past Family Fare Franchisees? Yes No If yes, let us know whoHave you ever worked part-time or full-time, on a temporary or permanent basis, in a retail establishment? Yes No If yes, please describeHave you ever been self employed or operated your own business? Yes No If yes, please describeHave you ever owned or operated a Franchised business? Yes No If yes, please describeAre you eligible to work in the United States? Yes No Are you bilingual? Yes No If yes, what languages do you speak?Have you ever had your wages garnished? Yes No If yes, date MM slash DD slash YYYY Please explainDriver's License State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Driver's License NumberRECEIPT OF THESE MATERIALS DOES NOT CONSTITUTE AN OFFER OF A FRANCHISE. An offer of a franchise is made only with the delivery of a Franchise Disclosure Document. Offerings are only made in states where franchise disclosure document is registered. See franchise disclosure document for more details.
