Confidential Application

1210 Northbrook Drive, Suite 310, Trevose, PA 19053

Please fax to (866) 449 - 0974

SECTION A - APPLICANT
First Name Initial Last Name (Jr/Sr) First Name Initial

www.ritasice.com
SECTION B - CO-APPLICANT (SPOUSE)
Last Name (Jr/Sr)

Social Secuirity No.

Social Secuirity No.

Current Street Address

Apt. No

Years at Address

Current Street Address

Apt. No

Years at Address

City

State

Zip

City

State

Zip

Previous Street Address

Apt. No

Years at Address

Previous Street Address

Apt. No

Years at Address

City

State

Zip

City

State

Zip

Date of Birth

Home Phone

Date of Birth

Home Phone

Email

Cell Phone

Email

Cell Phone

Current Occupation

Current Occupation

Sources of Income
Salary Bonus Investment/Interest Income Real Estate Income Other Total Are you a US Citizen? Yes No Salary Bonus Investment/Interest Income Real Estate Income Other

Additional Information
Are you a US Citizen? If not what is your current status? Yes No Have you ever been convicted of a Felony? (If yes, please explain on a separate attachment) No Have you ever filed for bankruptcy? If yes, Date Discharged: Yes Yes No No Are you planning on leaving your current position? Do you have any Legal Judgments against you? Yes Yes No No Yes No Yes No Yes No

$0.00 Total

$0.00

If not what is your current status? Have you ever been convicted of a Felony? (If yes, please explain on a separate attachment) Have you ever filed for bankruptcy? If yes, Date Discharged: Are you planning on leaving your current position? Do you have any Legal Judgments against you? Yes

Confidential Application - Page 2

Will you have a Partner: YES NO If so, please have each partner fill out a separate Confidential Application.

Name of Partner(s):

Area/Location Preference: 1. _________________

2. __________________ 3. ____________________

Amount of Cash Available for Investment: If you have retirement funds available, would you like more information on how to use

these funds penalty-free and tax-free to fund the franchise?

Yes No
LIABILITIES

ASSETS *Cash on Hand and In Banks *Marketable Securities Retirement Plans Accounts & Notes Receivable Real Estate Personal Property Business Holdings Other Total Assets Other Mortgages Accounts Payable Notes Payable Loans on Life Insurance

Credit Cards (Total Balance) Unpaid Taxes

$0.00 Total Liabilities

NET WORTH

$0.00

$0.00

I/we represent and warrant that all of the statements made by me/us in this application are true and correct. I/we understand that if I/we make a false statement, such action will terminate my/our application for consideration. I/we understand that by signing this application, I/we authorize Rita's Water Ice Franchise Company, LLC to check my/our credit report, criminal history, and/or arrest records with a credit bureau. I/we agree that this application shall be and remain the property of Rita's Water Ice Franchise Company, LLC whether or not this application is approved. I/we understand that this application does not obligate either party in any manner.

Applicant's Signature Print Name

Date

Co-Applicant/Spouse's Signature Print Name

Date

Your application must include the following items before it can be processed: *Current financial verifications of all listed liquid assets (Bank, Brokerage House), most recent pay period pay stubs, and Resume for each Applicant

First Contact HR Applicant Notice and Consent Document

Client Name: Rita's Water Ice (215-876-9340) Branch Code: CONT Service Code: (please select) Level 1C Client Code: RITAS

Level 1D Level 2C Level 2D Drug Level 1E Other _________ X

NOTICE TO JOB APPLICANTS

Your prospective employer has contracted with First Contact HR to verify certain information contained in your application for employment (including contract for services) or provided by you during the interview process. The information requested below is necessary to complete this task. This information is NOT a part of the application for employment and will be used for the sole purpose of verification of information, and or statements made by you. Please complete all information requested. It is possible that your employment may be determined in whole or in part by your prospective employer using data from a report supplied by First Contact HR, 535 West Pennsylvania Avenue, Suite 101, Fort Washington, PA 19034. Pursuant to Section 609 of the Fair Credit Reporting Act, you may be entitled to a copy of this report.
Applicants Legal Name Current Home Address Street Last City First State Zip M.I.

Date of Birth:
(Month/Day/Year)

Social Security #
State: Daytime Phone # Evening Phone #

Drivers License #

APPLICANT CONSENT: I understand and agree that First Contact HR will verify all or part of the information I have given my prospective employer. I understand that this verification may include an inquiry into my credit history, driving record, criminal and civil records, felony & misdemeanor and deferred adjudication records, as well as other public record information. I authorize the release of such information as may be necessary to verify the information I have provided. I release and hold harmless from all liability any individual or entity requesting or supplying information with respect to my application for employment.
APPLICANT SIGNATURE: DATE:

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