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First Name
*
Last Name
*
Email
*
Phone
*
Preferred location to run my IRIS Environmental Laboratories?
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
How much experience do you have in building and leading your own business?
*
Less than 1 year
1 - 4 years
4 + years
What is your timing to operate your own Inspection service franchise business?
*
Within the next 3 months
3 months to 6 months
6 months to a year
A year plus
Not sure yet, still researching the program
Are you military veteran?
*
Yes
No
Are you a field or back office oriented person?
*
Field
Back Office
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Personal Information
First Name
*
Last Name
City
*
State
*
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip Code
Residence Telephone
Cell Telephone
*
Fax Number
When Is Most Convenient Time To Call
Email Address
*
Date Of Birth (Month /day/ Year)
*
MM slash DD slash YYYY
Marital Status
*
Marital Status
Married
Widowed
Separated
Divorced
Single
U.s. Citizen
Yes
No
Education
Highest Grade Completed in High School
Highest Grade Completed in College
List Degree(S)
Other Education Completed & Dates
Business History
Present Employment
*
Brief Description of Responsibilities
*
Prior Employment
Brief Description of Responsibilities
*
Have You Ever Owned Any Other Business Not Listed Above
Yes
No
What is Your Strongest Business Aptitude:
Customer Service
Marketing
Accounting
What Did You Like Most About Your Job Or Business
*
What Was Least Desireable About Your Job Or Business
*
Your Strengths Are
*
What Is Your Greatest Achievement
*
Your Weaknesses Are
*
Interests & Hobbies
Interests & Hobbies
*
Charities Or Organizations You Belong To
*
Financial
Do You Own Or Rent Your Home
Own
Rent
Monthly Mortgage Or Rent $
*
Years Lived At Present Address
Years Lived In Present City
How Many Automobiles Do You Own
What Are They
Do You Have A Financing Source?
Yes
No
What Is Your Financing Source
Assets
*
Liabilities
*
US Government Securities $
Unpaid Income Tax $
Listed Securities & Current Market Value
Real Estate Mortgages Payable $
Unlisted Securities $
Mortgages & Other Liens Payable $
Owned Automobiles & Personal Property $
Other Debts Itemized
Cash Value Life Insurance
Notes Payable $
Retirement Plans & IRA’s
Total Credit Card Debt $
Real Estate Owned
Other Liabilities $
Other Assets
Total Assets $
Total Liabilities $
*
Net Worth
*
Income – Self
Income – Spouse
Bonus Income $
Total Income $
General
Do You Plan To Operate The Business Yourself
Yes
No
If Not, Who Will
Do You Intend To Have A Partner
Yes
No
If Yes, Who
Do You And/Or Your Partner Have Any Experience In Mold And/Or Asbestos? Please Explain
*
Do You Have A Preference As To The Area Or City Where You Would Like To Have Your Business Located, If So
Do You Have A Preference As To The Area Or City Where You Would Like To Have Your Business Located, If So
Please List In Order The Areas Of Preference
Address
*
City
State
County
Address
City
State
County
Address
City
State
County
Address
City
State
County
Why Do You Wish To Purchase A Franchise Rather Than Becoming Someone’s Employee Or Starting Your Own Business?
*
If Your Application Is Approved, When Would You Want To Open Your Business
How Did You Hear About Us
*
What Professional Goals Have You Set For Your Future
*
Applicant: Please Read & Sign
It is understood that the purpose of this questionnaire is for information only and is in no way binding upon IRIS Alliance, LLC or the applicant. It is, however, understood that the applicant supplies this information contained herein to the best of his or her knowledge and ability and that IRIS Alliance, LLC relies on this fact in assessing the desirability and qualifications of the applicant. This application may require IRIS Alliance, LLC to complete credit and other background checks on all applicants.
Signature
*
Date
MM slash DD slash YYYY
Signature
By typing my name in this field and sending the email I attest the desire to submit this form and release my information.
Print Your Name
I agree
*
Participant will not at any time or in any manner, either directly or indirectly, use for personal benefit, divulge, disclose or communicate in any manner any information that is proprietary to IAL. The Participant will protect such information and treat it as strictly confidential. The obligation of the Participant not to disclose confidential information shall continue for a period of three years. All information disclosed in any conversation, documentation or other presentation is considered confidential.Participant will not at any time or in any manner, either directly or indirectly, use for personal benefit, divulge, disclose or communicate in any manner any information that is proprietary to IAL. The Participant will protect such information and treat it as strictly confidential. The obligation of the Participant not to disclose confidential information shall continue for a period of three years. All information disclosed in any conversation, documentation or other presentation is considered confidential.
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