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Sears Store Application - PDF

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					                                               Confidential Application




              Hometown Store


Confidential Application



  Fax completed application to:
        1-847-286-7480
                                   or


                           Mail to:
                    Sears Hometown Stores
                     D/700-1DS B4-159B
                      3333 Beverly Road
                   Hoffman Estates, IL 60179

       Sears Recruiting Information Number: 1-888-259-2616
   For additional information or to apply online, visit our website at:

                www.searshometownstores.com
                                                                 Hometown Store
                                                  Confidential Application
                                                                 (Please complete in black ink)

Date


 PERSONAL DATA

Full Legal Name (no abbreviations or nicknames)

Last Five Digits of Your Social Security Number

Address (principal residence)                                                        City/State                 Zip

Driver's License Number                                                                                         State Issued


Are you a U.S. citizen?               Yes �       No �
                                                                                                                       ___
If you are not a U.S. citizen, please describe your visa status. _______________________________________________________


Home Phone (                  )                                                      Business Phone (       )

Fax Number (              )                                                          Cell Phone (       )

e-mail I.D. (required)

Previous Address (If less than five years at above address)

City/State/Zip


Where or how did you hear of this opportunity?


Which market location have you selected? (Required)              City/State

Have you ever owned your own business?                         Yes �          No �

If yes, describe (Including sales volume and earnings)




EDUCATION


High School Graduate                          Yes �           No �                   Grade Point Average

College Graduate                              Yes �           No �                   Grade Point Average


Special Activities/Interests/Membership (Civic, business, professional) List Activities




                                                   For immediate consideration fax to 1-847-286-7480
BACKGROUND

Have you ever been convicted of a felony or misdemeanor, other than a minor traffic violation?               Yes �             No �
    If yes, please state facts:


Have you ever declared bankruptcy?                                         Yes �          No �
    If yes, please state facts:


Has a civil judgement ever been rendered against you?                       Yes �         No �
    If yes, please state facts:


Have you ever been employed by Sears, Roebuck and Co.? Yes �                              No �      If yes, Please list Unit Number

Have you ever been employed by a Sears Hometown Store? Yes �                              No �       If yes, Please list Unit Number

Have you ever owned a Sears Hometown Store?                     Yes �              No �   If yes, Please list Unit Number

How many hours per week do you plan to devote to the business?

Who will operate the store?

Will other persons have an ownership interest or be involved in the management of the store?                 Yes �             No �

                      If yes, who:     Name:

                      Relationship:   (Spouse, Partner, Other-Describe)



BUSINESS/WORK EXPERIENCE (last 10 years)

                                                                                                                  Dates
 Present Occupation                                                     Position                                  Employed

 Company                                                                Address                                   City/State


 Describe duties, number of employees supervised and responsibilities



                                                                                                                  Dates
 Occupation                                                             Position                                  Employed

 Company                                                                Address                                   City/State


 Describe duties, number of employees supervised and responsibilities



                                                                                                                  Dates
 Occupation                                                             Position                                  Employed

 Company                                                                Address                                   City/State


 Describe duties, number of employees supervised and responsibilities



                                                                                                                  Dates
 Occupation                                                             Position                                  Employed

 Company                                                                Address                                   City/State


 Describe duties, number of employees supervised and responsibilities


                                                 For immediate consideration fax to 1-847-286-7480
  ASSETS AND LIABILITIES
ASSETS                                                                       LIABILITIES
Cash                                     $                                   Loans                                    $
Real Estate (Current market value)       $                                   Real Estate                              $
Savings                                  $                                   Income Tax Payable                       $
Securities                               $                                   Mortgages                                $
Automobiles                              $                                   Credit Cards                             $
Others (describe)                        $                                   Car Loans/Lease                          $
                                                                             Other Debts or Obligations               $
                TOTAL ASSETS             $                                                  TOTAL LIABILITIES         $
                                                                                                NET WORTH             $

Total cash available without borrowing                                       Other cash assets not described:

PROPERTY

Do you own or rent your principal residence?           Own �          Rent �                    Monthly Mortgage/Rent Payment   $

Do you own real estate other than your principal residence?          Yes �             No �       If yes, identify below

 Address and Type of Property                                                Title In                                 Monthly
 (Include private residence)                                                 Name of                                  Mortgage Payment $

 Mortgage                                    Year                            Mortgage                                 Present
 Holder                                      Aquired                         Balance $                                Market Value $


 Address and                                                                 Ti t l e I n                             Mon t h l y
 Type of Property                                                            Name of                                  Mortgage Payment $

 Mortgage                                    Year                            Mortgage                                 Present
 Holder                                      Aquired                         Balance $                                Market Value $


 Address and                                                                 Ti t l e I n                             Monthly
 Type of Property                                                            Name of                                  Mortgage Payment $

 Mortgage                                    Year                            Mortgage                                 Present
 Holder                                      Aquired                         Balance $                                Market Value $


BANK REFERENCES

Name under which your account appears

 Bank/Address                                                                City/State

 Bank/Address                                                                City/State

 Bank/Address                                                                City/State


CREDIT CARDS
                          Name                                                 Balance Due                                       Payment
                                                   ____
_________________________________________________________                                         ____
                                                                   ___________________________________                                           ____
                                                                                                                  ___________________________________

                                                   ____
_________________________________________________________                                         ____
                                                                   ___________________________________                                           ____
                                                                                                                  ___________________________________

                                                   ____
_________________________________________________________                                         ____
                                                                   ___________________________________                                           ____
                                                                                                                  ___________________________________

                                                   ____
_________________________________________________________                                         ____
                                                                   ___________________________________                                           ____
                                                                                                                  ___________________________________



Other Credit References




                                                For immediate consideration fax to 1-847-286-7480
   ASSETS AND LIABILITIES

Describe below, in detail, why you are interested in becoming a Sears Hometown Store Owner (Required).




This application does not constitute an offer to become a Sears Hometown Store Owner. It is strictly an application to be an independent
Sears Hometown Store Owner. It does not constitute an application for employment.

The undersigned acknowledges that operating an independent Retail Dealership has no guarantee of success and that Sears makes no
representations as to the business risks associated with owning and operating a Hometown Store. The risks and rewards, if any, are
primarily dependent on the individual operator.

The undersigned represents and warrants that the information furnished is full, truthful and accurate. The undersigned authorizes Sears or
its designated representatives to do the following as part of the application process and, if applicant is selected as a Sears Hometown Store
Owner and enters into a definitive Hometown Store Agreement with Sears, as part of any review of applicant’s financial status during the
term of the Hometown Store Agreement and any successor agreements thereto:

                        •   obtain consumer credit reports, including investigative consumer reports;*
                        •   obtain commercial credit reports;
                        •   conduct a background investigation, including the verification of any information furnished by the undersigned;
                        •   contact any references noted; and
                        •   provide any and all information contained in this application or obtained from any credit report, background
                            investigation or references, to any financial institution requesting such information for purposes of providing financing
                            related to Hometown Stores to the undersigned.

* These reports will provide, among other things, information on the character, general reputation, personal characteristics, or mode of living
of the undersigned and may be obtained through personal interviews with neighbors, friends, or associates, or with others with whom the
undersigned is acquainted or who may have knowledge concerning any such items of information.



Signature                                                                        Date



Print Full Legal Name


                                                    Fax completed application to:
                                                          1-847-286-7480
                                                                            or
                                                                    Mail to:
                                                             Sears Hometown Stores
                                                              D/700-1DS B4-159B
                                                               3333 Beverly Road
                                                            Hoffman Estates, IL 60179

                                                Sears Recruiting Information Number: 1-888-259-2616
                                            For additional information or to apply online, visit our website at:

                                                         www.searshometownstores.com

				
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Description: Sears Store Application document sample