Please provide information related to your work, employment history and business experience.

PERSONAL DATA
Applicants Last Name: Spouse’s Last Name:	Given Name 2nd Given Name 3rd Given Name	Applicants’ SIN: Spouse’s SIN:
Street Address:	How long at current address ?	Own Rent Board	Home Telephone No. Cell No.
City	Province	Postal Code	Bus. Telephone No.
Are you eligible to work in Canada? Yes No	Preferred Location: Are you willing to relocate? Yes No
	Applicants’ Drivers License No. Spouse’s Drivers License No. Personal Vehicle
EDUCATION
Highest Education
WORK RELATED SKILLS
Describe any of your work-related skills, experience or training that relate to this position.
PREVIOUS EMPLOYMENT OR BUSINESS EXPERIENCE
Name and address of most recent employer:	Job Title: Period of Employment Salary or Earnings:
ACKNOWLEDGEMENT
The applicant hereby makes the following statement as of (Date) The applicant hereby authorizes the staff of Hasty Market Corp. and its affiliates to make whatever investigations and inquiries they may consider necessary to obtain all relevant credit information.
PERSONAL FINANCIAL STATEMENT
Assets Cash on hand and unrestricted in banks Total Assets
FINANCIAL HISTORY - BANK ACCOUNTS: (Please complete in full)
Bank 1 Name	Bank 1 Address	Bank 1 Telephone	Bank 1 Balance
Bank 2 Name	Bank 2 Address	Bank 2 Telephone	Bank 2 Balance
Have you ever personally declared bankruptcy, or are you in the process of bankruptcy? Yes No
Have you ever been involved as an official in any company, which has declared bankruptcy, or is in the process of bankruptcy? Yes No
Has any judgment of any court been issued against you? Yes No
TERMS AND CONDITIONS
Please read the following statements carefully. You will be considered for a franchise only after you complete and sign the application. The information I have provided in this application is true and correct and I acknowledge that the company will be verifying this information. I understand that any untrue statement or misrepresentation of fact in my application will be justification for rejection of this application. I understand that awarding of any franchise / license is conditional upon the Company being satisfied with the results of independent reference, security and consumer reports (on a continuous basis and/or at renewal period), which may include information as to my character, general reputation, personal characteristics and mode of living obtained through personal interviews with neighbours, friends, associates, acquaintances or others who may have knowledge concerning such items of information. I hereby authorize such reports. I understand that if I am awarded a franchise / license, I am required to abide by all rules, regulations and policies of the Company as revised from time to time. I understand that the use of this application does not entitle me to a franchise / license and does not in any way obligate the Company to grant me a franchise / license. I understand that awarding a Franchise / License is subject to my providing proof of work eligibility, as required by Canadian law and my completion, satisfactory to the Company, of all of its pre-employment tests, procedures and training as may be required and the Company being satisfied with its review of the information and reports provided with this application. I agree that all information, materials and systems relating to the business of the Company received by me or of which I become aware by reason of this application, shall be held by me in strictest confidence and shall not be disclosed by me to anyone expect with the prior written consent of the Company and I further agree not to use or permit to be used, directly or indirectly, such information, materials or systems in any business competitive with the business of the Company. I Accept these conditions
PERSON TO BE NOTIFIED IN CASE OF ACCIDENT OR EMERGENCY (Name/Address/Telephone)
I authorize Hasty Market Corp. and its agents or assigns to exchange your personal information on an ongoing basis with credit bureaus and permit such organizations to verify your personal information in order to protect you, ensure the completeness of the information and maintain the integrity of the credit granting system, and to cooperate with local, provincial and national authorities in the investigation of unlawful or improper activities in order to protect you and us from fraudulent transactions.

Please enclose a cost of $285 administration fee for the processing of your application.