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_____________APPLICANT INFORMATION_____________
FULL NAME:
DATE OF BIRTH:
SSN:
PHONE:
CURRENT ADDRESS:
CITY:
STATE:
ZIP CODE:
E-MAIL ADDRESS:
LOCATION OF INTEREST:
WOULD YOU BE INTERESTED IN MEETING WITH THE ELLIANOS MANAGEMENT TEAM AT OUR OFFICE IN LAKE CITY,FL?
IF SO, WHEN?
______________BUSINESS EXPERIENCE______________
CURRENT BUSINESS EXPERIENCE:
CURRENT EMPLOYER OR COMPANY ADDRESS:
CITY:
STATE:
ZIP CODE:
PHONE:
FAX:
E-MAIL:
HOW LONG HAVE YOU BEEN WITH YOUR CURRENT EMPLOYER?
WHAT POSITION DO YOU HOLD?
HOURLY or SALARY?
ANNUAL INCOME:
HAVE YOU SERVED OR ARE YOU NOW SERVING AS US MILITARY, LAW ENFORCEMENT OR FIREFIGHTER?
HOW LONG DID YOU/HAVE YOU SERVED?
IF SEPARATED, WERE YOU SEPARATED UNDER HONORABLE CONDITIONS?
______________PREVIOUS EMPLOYER:______________
PREVIOUS EMPLOYER'S NAME:
PREVIOUS EMPLOYER'S ADDRESS:
CITY:
STATE:
ZIP CODE:
PHONE:
FAX:
E-MAIL:
HOW LONG WERE YOU WITH YOUR PREVIOUS EMPLOYER?
WHAT POSITION DID YOU HOLD?
HOURLY or SALARY?
WHAT WAS YOUR ANNUAL INCOME?
______________BUSINESS REFERENCE:______________
REFERENCE'S NAME:
ADDRESS:
CITY:
STATE:
ZIP CODE:
RELATIONSHIP TO YOU:
______________BUSINESS PLANS:______________
HOW DID YOU HEAR ABOUT US?
HOW INVOLVED DO YOU PLAN TO BE IN THE OPERATION OF THE STORE? ARE YOU PLANNING ON BEING AN OWNER/OPERATOR OR OPERATE THROUGH A MANAGER?
HAVE YOU FOUND A LOCATION FOR YOUR ELLIANOS?
HOW SOON WOULD YOU LIKE TO OPEN FOR OPERATION?
ARE YOU ABLE TO MEET THE FINANCIAL AND FRANCHISEE REQUIREMENTS? (Please explain)
HOW DO YOU PLAN TO FINANCE YOUR BUSINESS?
SIGNATURE	I have filled out this application completely and it is, to the best of my knowledge, true and accurate. I authorize Ellianos LLC to verify the information provided on this form as to my background and employment history. FULL NAME OF APPLICANT: FULL NAME OF CO-APPLICANT (if for joint account):