Candidate Questionnaire

Today's Date

Consent(Required)

By checking this box, I have read and agree to the below.

1. Confidential Information and Trade Secrets

I understand that the granting of a franchise is at the sole discretion of the Franchisor, Gideon Math and Reading, LLC. I understand that any information I receive from the Franchisor or from any employee, agent, or franchisee of the Franchisor or its affiliate is highly confidential (“Confidential Information”), has been developed with a great deal of effort and expense to the Franchisor, and is being made available to me solely because of this application.

Trade Secrets and Confidential Information shall not include any of the following:

(a) such information in the public domain at the time of the disclosure, or subsequently comes within the public domain without fault of the Receiving Party;
(b) such information which was in the possession of Receiving Party at the time of
disclosure that may be demonstrated by business records of Receiving Party and was not acquired, directly or indirectly, from Gideon; or
(c) such information which Receiving Party acquired after the time of disclosure from a third party who did not require Receiving Party to hold the same in confidence and who did not acquire such technical information from Gideon.

I agree that I shall treat and maintain all Confidential Information and trade secrets that are disclosed to Candidate in connection with the sale of a Gideon franchise and in training Candidate or its employees to operate the Center. I shall not, at any time, without the express written consent of the Franchisor, disclose, publish, or divulge any Confidential Information to any person, firm, corporation, or other entity, or use any Confidential Information, directly or indirectly, for my own benefit or the benefit of any person, firm, corporation, or other entity, other than for the benefit of the Franchisor.

2. Specific Understandings by Candidate

Candidate specifically acknowledges and agrees as follows:

(a) Consideration of this Questionnaire does not constitute the grant of a franchise.
(b) Only Gideon may agree to grant a franchise or make any other commitment with regard to a Gideon franchise, and any such agreement or commitment must be in writing signed by one of Gideon’s corporate officers.
(c) Gideon has authorized no one to make or agree to any oral modifications to the terms of a Gideon franchise agreement or to make any projections or estimates about the future earnings, sales or profits of any Gideon Center. Any such statements are acknowledged to be unreliable and have not been considered in connection with this Questionnaire or the purchase of a Gideon franchise.

Candidate's Name(Required)

If awarded a franchise, the candidate listed below would be owner/operator called the center director who would be physically present and directly supervising 75% of the time that the center is open for class. By signing your name below, you have read and agree to the above. You agree to the use of your electronic signature in lieu of an original signature on paper.

First Last

Personal Info

Candidate's Email(Required)

Enter Email Confirm Email

Candidate's Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Are you a U.S. citizen?(Required)

Yes

No

If not, what is your immigrant status?(Required)

Have you spoken with a lawyer to ensure your immigration status allows you to own AND operate a business in the United States?(Required)

What is your family situtation? Marital status, ages of any children living in the home, other caretakers, etc(Required)

Education

What is your native language?(Required)

English

Other

What other languages are your fluent in?

able to speak/read/write well

Undergrad. College/University Name & Location(Required)

Years Completed & Degree Subject & Type(Required)

Post Grad. College/University Name & Location

Years Completed & Degree Subject & Type

Criminal/Legal History

Have you or your spouse been a party to any litigation?(Required)

Yes

No

If yes, please explain and list the cause number and court of jurisdiction.(Required)

Have you or your spouse ever been arrested?(Required)

Yes

No

If yes, please explain.(Required)

Have you or your spouse ever been convicted of a crime?(Required)

Yes

No

Do not mention traffic violations.

If yes, please explain.(Required)

Employment History

Start with most recent employer.

Company Name(Required)

Dates of Employment & Reason for Leaving(Required)

Month/Year

Position Title & Description of Duties(Required)

Company Name(Required)

Dates of Employment & Reason for Leaving(Required)

Month/Year

Position Title & Description of Duties(Required)

Have you ever owned your own business and/or franchise?(Required)

If yes, please describe.

Candidate's Financial Statement

Proof of information listed will be needed later.

List Liquid Asset Amounts.(Required)

In Bank Accounts $

In Other Areas $

TOTAL

What percentage (%) of needed start-up costs will be from:(Required)

For retail franchises, we require at least $100,000 in liquid assets and/or financing for start-up and first year funds.

Personal Assets

Financing

If needed, what is your source of financing?(Required)

List Debt Amounts.(Required)

Mortgage

Car Loans

Credit Cards

Student Loans

Bank Loans/Other

TOTAL

A credit report will be run later.

Please mark any that are true.(Required)

I have had a debt that has gone to collection in the last 7 years.

I have filed for bankruptcy in the last 7 years.

I have had neither issue (debt collection or bankruptcy) in the last 7 years.

List Monthly Income(Required)

Net Salary (yourself)

Net Salary (spouse)

Other

TOTAL

List Monthly Liabilities(Required)

Mortgage/Rent

Car + Debt Payments

Living Expenses

TOTAL

Accuracy of Questionnaire - I certify that the information I have provided on this questionnaire is complete and correct. I understand that false or misleading statements on this form are grounds for termination of the application process or, if discovered after I obtain a franchise, for termination of the franchise.(Required)

By checking this box, I have read and agree to the above.

Candidate's Signature

First Last

Phone

This field is for validation purposes and should be left unchanged.

S3. Candidate Questionnaire

Personal Info

Education

Criminal/Legal History

Employment History

Desired Locations

Candidate's Goals

Candidate's Financial Statement