Verification Form

I certify that this information is correct. I have carefully read and submitted the foregoing information provided on the pages of this statement. The information is presented as a true and accurate statement of my/our financial condition on the data indicated. I/we agree that if any material change(s) occur(s) in my/our financial condition that I/we will immediately notify the Corporate Office of said change(s) and unless Family Safe Homes is so notified it may continue to rely upon the application and financial statement and the representations made herein as a true and accurate statement of my/our financial condition. I/we authorize Family Safe Homes to make whatever credit inquiries/background checks it deems necessary in connection with this application and financial statement. I/we authorize and instruct any person or consumer reporting agency to furnish to Corporate Office any information that it may have to obtain in response to such credit inquiries.nIn consideration of the ongoing association between Senior Safe Homes and the undersigned applicant (hereinafter “Applicant”), the parties hereto have entered into this Non-Disclosure and Non-Competition Agreement. WHEREAS, in the course of its business operations, Family Safe Homes provides its customers products and services which, by nature of the business, include trade secrets, confidential and proprietary information, and other matters deemed material or important enough to warrant protection; and WHEREAS, Applicant, by reason of his/her interest in Family Safe Homes and in the course of his/her duties, has access to said secrets and confidential information; and WHEREAS, Family Safe Homes has trade secrets and other confidential and proprietary information, including procedures, customer lists, and particular desires or needs of such customers to which Applicant has access in the course of his/her duties as an Applicant. Now, therefore, in consideration of the premises contained herein, the parties agree as follows Applicant shall not, either during the time of his/her franchise evaluation with Family Safe Homes or at any time thereafter either directly or indirectly, communicate, disclose, reveal, or otherwise use for his/her own benefit or the benefit of any other person or entity, any trade secrets or other confidential or proprietary information obtained by Employee by virtue of his/her employment with Family Safe Homes, in any manner whatsoever, any such information of any kind, nature, or description concerning any matters affecting or relating to the Family Safe Homes business, or in the business of any of its customers or prospective customers, except as required in the course of his/her employment by Family Safe Homes or except as expressly authorized Family Safe Homes, in writing. During any period of evaluation with Family Safe Homes, and for two (2) years thereafter, Applicant shall not, directly or indirectly, induce or influence, divert or take away, or attempt to divert or take away and, during the stated period following termination of employment, call upon or solicit, or attempt to call upon or solicit, any of the customers or patrons Family Safe Homes including, but not limited to, those upon whom he/she was directly involved, or called upon, or catered to, or with whom became acquainted while engaged in the franchise evaluation process of a Family Safe Homes franchise business. Further, Applicant shall not make any use of the information described herein, or cause or attempt to cause any other person to use such information for purposes other than the business of Family Safe Homes.
  • Franchise Applicant