Application

Getting to Know You
HomeBusinessStrategies.org wants to better understand how we can best serve your needs. Personal information supplied on this form will be used to help us consider and evaluate your background and experiences, and also to track services we provide to you. This information will not be shared outside of HomeBusinessStrategies.org.

Required Fields*

General Information:*

Physical Address / Location of Home: (if different from mailing)

Highest Level of Education Completed:

What school did you attend? Completed? If yes - in year:

The following information is requested by the federal government in order to monitor compliance with federal laws prohibiting discrimination against applicants or recipients on the basis of ethnicity, race or gender. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish this information, then HomeBusinessStrategies.org is required to note the ethnicity, race and gender of individual applicants on the basis of visual observation or surname. Answers to the following questions can help us to better determine a specific field or type of work that will give you a better opportunity to succeed. There are advantages for those of specific ethnic origins.

(Please complete this section)*

Gender: Female Male

Ethnicity / Race: Hispanic Non Hispanic

Native American Caucasian Pacific Islander Asian African American

Other (please specify:

Applicant’s marital status: Single Married Separated

What is your primary language spoken?

If it is not English, is English also spoken? Yes No

Emergency Contact Information
Please list a relative or friend who would definitely know how to contact you, even if you move:

Your Employment Information

Do you now own or run any other Business? : Yes No

If yes, what is your company name? :

Job Title: Length of time on job:

Have you ever owned or run any other Business? :  Yes No

If yes, what was the name of the company? :

Job Title: Length of time on job:

Primary Employment Status (choose one):*

Applicant Personal Statement*

Please specify the programs where you can use assistance, or are interested in:

Are you seriously interested in starting a business? Yes  No

Are you willing to commit the time and effort required to study, learn and make it a success? Yes No

Do you already have a business plan? Yes No

Do you already have a business started? Yes No

If yes, what is the name and nature of your business?

My biggest concern about starting and/or expanding my own business is:

Do you own a car? Yes No

Are you familiar with using a computer? Yes No - If yes which platform? : Mac PC

Do you own or have ready access to a computer? Yes No

Computer Skills:

If you have access to a computer, is it connected to the Internet? Yes No

Are you a self starter? Yes No

Are you able to follow through with a task or assignment? Yes No

Do you consider yourself to be reliable? Yes No

Do others consider you to be reliable? Yes No

Are you determined, ready to learn and to follow the course materials specific to the business opportunity that you will enter into and do whatever it takes to master the principles and steps that will lead to success in it?

Yes No

Are you willing to invest in the advanced training and courses that are proven to give you the knowledge, business advantages and strategies that it takes to become one of the top ten percent in your chosen field of business?

Yes No

Are you now willing to commit or pledge that you will take the business opportunity that you enter into with HomeBusinessStrategies.org, not as a part-time hobby, but as a serious business endeavor, and give it the weight of importance in your life that is required to bring you financial freedom?

I Agree I Disagree

How did you learn about HomeBusinessStrategies.org?

Internet Poster Advertisement Radio Friend Other

If poster, advertisement or radio, please indicate the specific details and source of your learning about us:

References (At least two please)

Applicant Certification*
By checking the box below, I certify that all information provided on this application is accurate and complete to the best of my knowledge.

I Agree    I Disagree

Applicants must be at least 18 years old.