Franchising
Join The Chooks Club

Franchisee Evaluation and Disclosure Form

1. Location preferences (town/city/suburb)


First choice: Second choice:
Reasons: Reasons:
Third choice: Where did you hear about us?
Reasons: Specify which:


2. Personal information


Surname: Christian names:
Address:
Post code:  
Telephone: Mobile:
Email:
Date of birth
(dd/mm/yy):		 Driver's
licence no.:
Name & age of children:
Marital status: Other dependents:
Spouse's name: Spouse's occupation:
  Describe any physical disabilities or limitations you may have:
 
  Describe any convictions other than minor traffic offences:
 
  Describe and provide dates of any Workers' Compensation claims:
 
  List membership of Unions, Lions, Rotary etc.:
 


3. Education background


Last High School attended: Year left:
Standard achieved:  
Further education: technical/tertiary:
Other courses/studies/qualifications:


4. Employment history


Present occupation/position:
Company name:
Company address:
Commencement date (dd/mm/yy): Reporting to:
  Describe duties and responsibilities:
 

Previous employment (most recent first)
Position: Commencement date
(dd/mm/yy):
Company name
and address:
Phone: Reporting to
(name):
Reason for leaving:
Position: Commencement date
(dd/mm/yy):
Company name
and address:
Phone: Reporting to
(name):
Reason for leaving:
Position: Commencement date
(dd/mm/yy):
Company name
and address:
Phone: Reporting to
(name):
Reason for leaving:


5. Business experience


Have you ever been self-employed? If so, please give details:
Have you ever had a business failure? If so, please give details:
Do you have a registered company? Please give details including director's names and equity:
Have you or a company owned or controlled by you ever been involved in bankruptcy? Please give details:


6. General information


How did you first hear about CHOOKS fresh & tasty?
Why do you believe CHOOKS fresh & tasty would be a suitable franchise for you?
How would you describe your personality traits?
What are your ambitions in life?


7. References


a) Personal
Name: Occupation:
Address: Phone:
Name: Occupation:
Address: Phone:
Name: Occupation:
Address: Phone:
b) Business
Name: Occupation:
Address: Phone:
Name: Occupation:
Address: Phone:
Name: Occupation:
Address: Phone:


8. Financial position


Assets Liabilities
Cash in bank: Bank loan (mortgage):
Real estate: Bank loan (car):
Superannuation: Bank loan (other):
Shares: Credit cards:
Other (please list): Other (please list):
Total: Total:
Assets Liabilities
Cash in bank: Bank loan (mortgage):
Real estate: Bank loan (car):
Superannuation: Bank loan (other):
Shares: Credit cards:
Other (please list): Other (please list):
Total: Total:
 
How would you finance the franchise start up costs (e.g. licence fee)?
Do you require assistance from CHOOKS fresh & tasty to organise finance?