麦当劳受许人申请表.doc

窗体顶端1. Personal Information (个人信息) * 表示必填信息English Name英文姓名* Chinese Name中文姓名Maiden Name or any Alternate Names Used婚前名或曾用名* Place of Birth出生地点* Date of Birth出生年月* Sex性别男 女 Passport No护照号码* I.D. Card No.身份证号码* Home Tel. No.(with area code)住宅电话号码(包括区号)* Personal Mobile个人移动电话号码* Personal Email address :个人电子邮件地址：* Current home address: 目前的家庭住址：Previous home address: 前家庭住址：* Nationality (including any dual nationality):国籍（包括任何双重国籍）：Former Nationality (if any):之前国籍（如有的话）：MaritalStatus (select one)婚姻状况(选一个)Single/Never Married未婚Separated分居Married已婚Divorced离婚Widowed丧偶Spouse 配偶 English Name英文姓名Chinese Name中文姓名Place of Birth出生地点Date of Birth出生年月I.D. Card No.身份证号码Occupation(if not working, last occupation)职业 (如目前无工作, 请列出最后的职业)Employer (if not working, last employer)雇主 (如目前无工作,请列出最后的工作单位)Present Residential Address 目前居住地址Child 儿女 +English Name英文姓名Chinese Name中文姓名Place of Birth出生地点Date of Birth出生年月I.D. Card No.身份证号码Occupation(if not working, last occupation)职业 （如目前无工作,请列出最后的职业）Employer (if not working, last employer)雇主 （如目前无工作,请列出最后的工作单位）2. Education ( 教育背景) Type of School学校 Name, address and phone number of school/university学校名称,电话号码和地址 Subject专业 From -To起止时间 Degree?Y / N是/否有学位?(请列出) Certificate #证书编号 Secondary School中学Y N Vocational School职校/技校Y N University大学Y NOther Courses +其他进修课程Y NScholarship obtained +所获奖学金Y NOther Professional Qualifications +其他专业资质Y N3. Business Experience（商业经验）Present occupation目前职业状况：* Position职位：* Dates employed起始日期：* Company公司名称：* Address地址：* Telephone number电话：Fax number传真：Website address网址：Describe duties, number ofemployees supervised描述工作职责及所管理的员工数量：Previous business experience(List most recent first.)过去的商业经验（从最近的开始）* Have you ever owned your ownbusiness or franchise? If so, explain.是否曾拥有自己的生意或特许经营店？如是，请介绍：* Have you ever had a business failure?If so, explain是否曾经历生意经营失败？如是，请介绍：4. Miscellaneous Information（其他)* The flexibility to relocate may be required。 To which general geographic area（s）would you be willing to relocate for a restaurant opportunity可以前往特许经营之县市/省 (请依个人意愿依先后顺序填写)List any hobbies， community activities， special interests or other pertinent information列出您的嗜好、常参加的小区活动、特别兴趣或其它相关的信息* Are you related by blood or marriage to any officer of McDonalds China是否有亲戚在麦当劳任职？ 是 否* Have you ever worked in a McDonalds restaurant？If so， where and when？您曾在麦当劳餐厅工作过吗？如果是，何时？在哪家餐厅？* Have you ever applied for a McDonalds franchise？ If so， where and when？您曾经申请参加麦当劳特许经营吗？如果是，何时？5. Please list at least 2 references. We may contact them for further information regarding your information (请列出至少两位最能评估您过去的表现与实力的人士。本公司在必要时可能会与他们联络，以进一步了解您的情况)* 姓名Name* 单位Company* 职位Position* 关系Relationship* 联系电话Telephone6. PERSONAL FINANCIAL STATEMENT/个人资产状况 （Significant Property Holdings and Business Interests.(所拥有的较大价值的财产以及从事的其他商业活动) INCOME STATEMENT FOR 12 MONTH PERIOD ENDING截至 年 月，12个月期间的收入状况 Salary, wages, bonus, commissions工资、奖金、佣金RMB $ Dividends, interest股息、利息 Other income - specify source, e.g., business profits (self-employed), trust, etc.其他收入，列出具体来源，如自有生意的利润、信托投资收益等* TOTAL总额RMB $Please provide details on the following asset verification schedulesschedule numbers in parentheses) 请提供以下资产清单 .Assets/资产RMB $Liabilities/负债RMB $ Cash on hand and in banks现金及银行存款总额RMB $ Loans/notes/accountspayable借款/票据/应付款RMB $ Vested profit sharing分得的利润RMB $ Real estate mortgages不动产抵押RMB $ Securities, Bonds/debentures证券和债券RMB $ Other debts or obligations其他负债或义务RMB $ Notes, accounts and mortgagesreceivable票据、应收款RMB $ Real estate-current market value不动产-市场现值RMB $ Net value of business interests自有生意的净值RMB $ Other-automobiles and otherpersonal property, etc.其他-汽车和其他动产RMB $* Total liabilities/总负债RMB $* Total assets/总资产RMB $ Net Worth/净资产RMB $7. Please answer the following (请回答以下问题)7.1 CIVIL/CRIMINAL LITIGATION AND REGULATORY MATTERS/民事诉讼刑事诉讼和其他法律事项* Have you, your spouse, or any business concern you ever controlled, were employed by, served as an officer or director of, or had an ownership interest in,ever been arrested or charged with any crime or offense (other than minor traffic violations)? If yes, provide the following information with regard to any indictment, information, accusation, summons, complaint, arrest or conviction below. /您、您的配偶或您曾控制、受雇、任董事或高级管理职位或持有所有人权益的任何商业组织是否曾被捕、被控刑事犯罪或违法（轻微之交通违章事件除外）* Have you, your spouse, or any business concern you ever controlled, were employed by, served as an officer or director of, or had an ownership interest in, been a plaintiff or defendant in any civil matter in a court of law (including debt collection matters or bankruptcy proceedings) or been the subject of a judgment? If yes, provide the details below. / 您、您的配偶或您曾控制、受雇、任董事或高级管理职位或持有所有人权益的任何商业组织是否曾作为任何民事审判（包括债务追偿和破产程序）的原告或被告或者是一项判决的被执行方？* Has a bankruptcy petition ever been filed for you, your spouse, or any business concern you ever controlled, were employed by, served as an officer or director of, or had an ownership interest in? If yes, provide the details below, including the name of the petitioner, the date of the petition and where that petition (jurisdiction) was filed/是否曾发生针对/您、您的配偶或您曾控制、受雇、任董事或高级管理职位或持有所有人权益的任何商业组织的破产申请？如果是，请提供细节，包括申请人、申请时间和地点（管辖地）。* Have you ever been involved with non-routine governmental inquiries, investigations, criminal proceedings, regulatory or enforcement actions in any country? If so, please explain in detail, providing all relevant dates and a description of the reason(s) for the investigation or proceeding, the conduct alleged, the names and addresses of the persons involved, the name and nationality of the investigating or law enforcement entity, the result of the investigation or proceeding, including any penalties imposed, any ongoing legal disabilities imposed, and any other relevant information (use additional sheets as necessary)/您是否在任何国家曾受到非常规的政府询问、调查、刑事程序，监管或强制措施？.如是，请详细解释，提供所有有关的日期和关于该等调查或措施的原因、受质疑的行为、涉及人员的名字和地址、调查或执法机关的名称和所属国、调查或措施的结果，包括给予的处罚、持续有效的法律限制，以及如何其他有关信息（如有需要请使用额外的纸张）。7.2 U.S. Foreign Corrupt Practices Act and Local Anti-Corruption Laws/美国海外反腐败法和当地反腐败法律* Are you aware of the requirements of the U.S. Foreign Corrupt Practices Act and international or local anti-bribery laws? /您是否了解美国海外反腐败法和国际或国内的反贿赂法律？* Have you ever offered, promised, or received requests for payments of any kind, gifts, or unreasonable entertainment of or from government officials or employees? If yes, please describe the circumstances of the offer, promise or request and how you responded to it/您是否曾提出或承诺或被要求对政府官员或雇员给予任何形式的给付、礼物或不合理的招待？如是，请描述提出或承诺或被要求的情形以及你如何回应该等要求。* Have you ever been involved in a violation (either alleged, charged, investigated or indicted) of the U.S. Foreign Corrupt Practices Act, any national anti-bribery law or been investigated and/or debarred by the World Bank or government entity? If yes, explain/您是否曾涉及违反美国海外反腐败法或任何国家的反贿赂法或受到世界银行或政府机构调查和/或禁制？如是，请解释.* Please indicate if you or any of your immediate family can be categorized as one or more of the following (“Immediate family” means parents, brothers, sisters, children and each of their spouses): a current or former official or employee of a national, provincial or local government or government entity; a current or former official of a political party; a current or former candidate for public office; a current or former employee, director or manager of any state-controlled or state-owned enterprise. (State-controlled and state-owned enterprises include any business that is owned or controlled by any national, provincial or local government.); a current or former employee or official of a public international organization, such as the World Bank, the International Monetary Fund, the United Nations, the Asian Development Bank and the European Union; or a current or former official with any consulting, ceremonial or titular positions for any government entity. If yes, please provide the name of the person holding the position and dates and position held/请陈述您或您的任何直接家庭成员（指父母、兄弟、姐妹、子女及其