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Applicant's Name McDonald's USA, LLC Application for a Franchise Confidential This application does not obligate either party in any manner. I submit the following information as my complete and true personal and financial condition as of the date shown below. In accordance with the Privacy Act (5 U.S.C. 552 a), Freedom of Information Act, I expressly authorize any past or present employer, any law enforcement agency, federal, state or local, or any person who has personal knowledge of my character, work experience or criminal records to release this information to McDonald's USA, LLC (“McDonald’s”). I understand and acknowledge that, as a condition of being considered for the McDonald's franchisee training program, I must submit to a credit history check and criminal background check to be performed by a third party entity of McDonald's choice. The purpose of these checks is purely commercial in nature, in furtherance of a potential commercial business relationship between McDonald’s and me. I understand McDonald’s may use those results of the credit history and criminal background check in determining whether I will be placed into the franchisee training program or remain in McDonald's franchisee training program. McDonald’s does not seek and will not use the results of these checks for any other non-commercial purpose. If requested by McDonald's, I agree to supply statements from my professional advisors (i.e., banker, broker, accountant or attorney) verifying the above assets, and I also agree to furnish copies of federal income tax returns as filed for the last five years. I understand that McDonald's is relying upon all the above information as a material factor in considering my application to become a McDonald's franchisee, and I therefore agree to promptly notify McDonald's of any material change in any of the above information or any subsequent information provided to McDonald's. In addition, I release all persons from liability as a result of true, accurate information. I also certify that neither I nor any of my funding sources is, or has ever been, a terrorist or suspected terrorist, or a person or entity described in Section 1 of U.S. Executive Order 13224, issued September 23, 2001, as such persons and entities are further described at the Internet website www.ustreas.gov/offices/enforcement/ofac. I agree to comply with and/or to assist McDonald’s to the fullest extent possible in McDonald’s efforts to comply with the above Executive Order. Signature (Applicant) Date Signature (Spouse) Date

McDonald's USA, LLC Application for a Franchise · Applicant's Name . McDonald's USA, LLC . Application for a Franchise. Confidential . This application does not obligate . either

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Page 1: McDonald's USA, LLC Application for a Franchise · Applicant's Name . McDonald's USA, LLC . Application for a Franchise. Confidential . This application does not obligate . either

Applicant's Name

McDonald's USA, LLC Application for a Franchise

Confidential This application does not obligate

either party in any manner.

I submit the following information as my complete and true personal and financial condition as of the date shown below. In accordance with the

Privacy Act (5 U.S.C. 552 a), Freedom of Information Act, I expressly authorize any past or present employer, any law enforcement agency,

federal, state or local, or any person who has personal knowledge of my character, work experience or criminal records to release this information

to McDonald's USA, LLC (“McDonald’s”). I understand and acknowledge that, as a condition of being considered for the McDonald's franchisee

training program, I must submit to a credit history check and criminal background check to be performed by a third party entity of McDonald's

choice. The purpose of these checks is purely commercial in nature, in furtherance of a potential commercial business relationship between

McDonald’s and me. I understand McDonald’s may use those results of the credit history and criminal background check in determining whether I

will be placed into the franchisee training program or remain in McDonald's franchisee training program. McDonald’s does not seek and will not

use the results of these checks for any other non-commercial purpose. If requested by McDonald's, I agree to supply statements from my

professional advisors (i.e., banker, broker, accountant or attorney) verifying the above assets, and I also agree to furnish copies of federal income

tax returns as filed for the last five years. I understand that McDonald's is relying upon all the above information as a material factor in considering

my application to become a McDonald's franchisee, and I therefore agree to promptly notify McDonald's of any material change in any of the above

information or any subsequent information provided to McDonald's. In addition, I release all persons from liability as a result of true, accurate

information. I also certify that neither I nor any of my funding sources is, or has ever been, a terrorist or suspected terrorist, or a person or entity

described in Section 1 of U.S. Executive Order 13224, issued September 23, 2001, as such persons and entities are further described at the Internet

website www.ustreas.gov/offices/enforcement/ofac. I agree to comply with and/or to assist McDonald’s to the fullest extent possible in

McDonald’s efforts to comply with the above Executive Order.

Signature (Applicant) Date Signature (Spouse) Date

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Note: Use the "tab" key to navigate to the next field. Typed applications are preferred, versus hand written, to ensure we are able to read your information. Also, numeric fields asking for a "total" will be automatically calculated, however, you should verify the information is correct.
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PERSONAL INFORMATION

Name Primary phone Secondary phone

Residence E-Mail Address

City

State Zip code How long at this address?

Spouse's name

Previous Address:

Have you ever been convicted of a felony within the past 7 years, or convicted of a felony that has resulted in your release from prison in the past 7 years, that has not been sealed, expunged, annulled, erased, pardoned or otherwise removed from your conviction record? Has any judgment ever been entered against you or your company or your employer where you were one of the litigants? Do not consider juvenile or youthful offend convictions when responding to this question. If yes, explain.

Have you or your spouse ever declared personal bankruptcy? If yes, explain.

Are you or have you ever been a sex offender registered with any federal, state or local government agency, including any listing on a public website? If yes, explain.

Are you authorized to work in the United States as a McDonald’s franchisee? YES NO

Are you fluent in another language? YES NO

Are you fluent in another language? YES NO If YES, which language?

EDUCATION

Last year of school completed Name of college and/or postgraduate school Degree

BUSINESS EXPERIENCE

Present occupation Position Dates employed

Company Address

Describe duties, number of employees supervised and responsibilities

Manager Name Manager Phone May we contact for a reference? YES NO

Previous business experience (List most recent first.) Occupation Position Dates Employed Reason left

Company Address

Describe duties, number of employees supervised and responsibilities

Manager Name Manager Phone May we contact for a reference? YES NO

Occupation Position Dates Employed Reason left

Company Address

Describe duties, number of employees supervised and responsibilities

Manager Name Manager Phone May we contact for a reference? YES NO

Have you ever owned your own business or franchise? If so, explain.

Have you ever had a business failure? If so, explain.

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PROFESSIONAL EXPERIENCE: Below are a number of areas related to your professional experience. Please select the level of experience you have in each area, and briefly describe the experience.

No experience in this area

1

Limited experience

2

Skilled

3

Highly Skilled

4

Expert in this area

5

How would you describe your level of experience in:

Recruiting and training successful work teams. 1 2 3 4 5 Briefly describe your experience in this area.

Creating and implementing business plan with short and long term goals. 1 2 3 4 5 Briefly describe your experience in this area.

Thriving in a customer centric environment. 1 2 3 4 5 Briefly describe your experience in this area.

Full financial responsibility for results of a business unit, including capital investment decisions. 1 2 3 4 5 Briefly describe your experience in this area.

Managing teams in a fast paced, high pressure work environment. 1 2 3 4 5 Briefly describe your experience in this area.

Working in a highly standardized operational environment. 1 2 3 4 5 Briefly describe your experience in this area.

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PERSONAL FINANCIAL STATEMENT

INCOME STATEMENT FOR 12 MONTH PERIOD ENDING ___________________________________

Salary, wages, bonus, commissions Dividends, interest Other income - specify source, e.g., business profits (self-employed), trust, spouse, etc. TOTAL

Please provide details on the following asset verification schedules (schedule numbers in parentheses).

Assets Liabilities Cash on hand and in banks Loans/notes/accounts payable (3) Vested profit sharing Real estate mortgages (6) Securities, Bonds/debentures (1) Other debts or obligations (5) Notes, accounts and mortgages receivable (2) Real estate-current market value (6) Total liabiltiesNet value of business interests (7) Total Assets Other-automobiles and other personal property, etc. (4) Net Worth (Assets less liabilities) Total assets

ASSET VERIFICATION SCHEDULES

(1) Listed securities, bonds/debentures No. shares Description Pledged (yes/no) Current mkt. value

TOTAL

(2) Notes/accounts/mortgages receivable Maturity Original Monthly Present

Debtor Relation to applicant Nature of debt date face value payment balance

Total

(3) Loans/notes/accounts/bills payable (excluding mortgages) Relation Secured Maturity Original Monthly Interest Present

Lender to applicant Nature of debt yes/no date face value payments rate balance

Total

(4) Other Assets (5) Other debts and liabilities (e.g., stock options, cash value of life insurance, automobiles and other personal property, etc.)

(e.g., insurance loans, alimony, child support, leases, contracts, legal claims, judgments, chattel mortgages, taxes, comaker or guarantor, etc.)

Current fair Description market value Obligee Description Amount

Total Total

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ASSET VERIFICATION SCHEDULES-- Continued

(6) Real estate Address and description of Original Mo. payments Current property (residential, rental, Date Title in Original mortgage (incl. taxes, Current mortgage vacant) acquired name(s) of Cost amount assessments) market value balance Net Value

Total

(7) Business Interests Type Net (partner, Buy/sell value

Name and address corp., Names of Relation to Percent agreement Valuation your of business Description sole) all owners applicant equity yes/no method interest

Total

Does your spouse or another person have any interest in any of the above assets? If yes, please explain and list assets.

Have any of the above assets been acquired by you as a gift? If yes, specify assets, from whom and when.

MISCELLANEOUS INFORMATION

List any hobbies, community activities, special interests or other pertinent information

Are you related by blood or marriage to any officer of McDonald's USA, LLC? YES NO Name Relationship

Are you or your employer providing products, goods or services to McDonald's or franchisees of McDonald's? If yes, please attach detailed information.

Will you devote your full time to this business? YES NO

The flexibility to relocate may be required. To which general geographic area(s) would you be willing to relocate for a restaurant opportunity (i.e., Northwest, Southwest, Midwest, Northeast, Southeast)?

Have you ever worked in a McDonald's restaurant? If so, where and when? YES NO

Have you ever applied for a McDonald's franchise? If so, where and when? YES NO

Personal references (other than employers or relatives): Name in full Relationship Company / Occupation Years known Phone #

Name in full Relationship Company / Occupation Years known Phone #

Name in full Relationship Company / Occupation Years known Phone #

U.S. Application Form.doc. 5/24/2017

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