Apply Here Stage 4

Have you worked for a Boots Opticians or D&A as a locum? * Yes No
(If yes please give details)

Offences and Convictions

Have you ever been convicted of a criminal offence? * Yes No
(If yes please give details)

Have you been charged with any offences (including driving) and are waiting the
outcome of a hearing? * Yes No
(If yes please give details)

General

Are you able to supply at least 2 references on request (not from family members)? * Yes No

How does your spouse/partner feel about your plans to own your own business?

How long are you prepared to commute to your place of work: miles* mins:*

Would you consider relocating? * Yes No
(If yes please give details)

Are you a partner or director in any other business? * Yes No
(If yes please give details)

What are the main reasons you wish to own your own business:*

What attracts you in particular to owning a Boots franchise:*

What qualities do you have that you think will contribute to your success in business:*

Have you any previous experience of running a business:? *

CONFIDENTIALITY STATEMENT

I certify that all the information given on this application form is true and accurate and that Boots Opticians may consider me for a franchise based on this information.

I acknowledge that all such information and documentation as may be now or in the future be disclosed to me is confidential and remains the property and copyright of Boots Opticians.* Yes

I undertake, that except as permitted by any prior written agreement, no such information or documentation as I may now or subsequently receive or obtain shall in any circumstances, be disclosed to any person, firm or company, or be used by me, any associates of mine or any firm in which I have or may acquire an interest.* Yes

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Employment History:

Offences and Convictions

General

CONFIDENTIALITY STATEMENT