Fillable Printable Nissan Job Application Form
Fillable Printable Nissan Job Application Form
Nissan Job Application Form
NISSAN NORTH AMERICA, INC.
Personal Information
Date
Name (First, Middle, Last) Social Security Number Driver’s License Number/State
- - /
Home Address (Street, City, State, Zip Code)
Business Address (Street, City, State, Zip Code)
Home Telephone Number Business Telephone Number
( ) ( )
Education
Years School Degree Major
High School
College
Graduate Degree
List any other education or training you believe will be helpful for your ownership or operation of a Nissan dealership.
Employment
Have you ever been employed, in any capacity, by a Nissan or Infiniti Dealer? NO YES
If YES, please complete below.
Period From/To Dealer Name Dealer Address
1
2
3
Do you now own, operate, or have a financial interest in or have you previously owned, operated or had a financial interest in any automobile
dealership? NO YES If YES, please complete below.
Name of Dealership Vehicle Lines Financial
Interest %
Period
From/To
Title/Position Reason for
Terminating
1
2
3
Attach current and prior year-end financial statement, customer satisfaction and sales
performance reports for each manufacturer listed above.
Application for Nissan Dealer Sales and Service Agreement 1 of 7
NISSAN NORTH AMERICA, INC.
Have you or any members of your immediate family, relatives or in-laws been employed by Nissan North America, Inc., its subsidiaries or its
distributors? NO YES If YES, please complete below.
Name Location Position Held Period From/To Relationship
1
2
Outline in chronological order the positions or businesses in which you have participated during the past 10 years, most recent
first.
1 Period From/To Position/Business Name of Firm Type of Business
Telephone Number Supervisor Reason for Leaving
( )
2 Period From/To Position/Business Name of Firm Type of Business
Telephone Number Supervisor Reason for Leaving
( )
3 Period From/To Position/Business Name of Firm Type of Business
Telephone Number Supervisor Reason for Leaving
( )
4 Period From/To Position/Business Name of Firm Type of Business
Telephone Number Supervisor Reason for Leaving
( )
5 Period From/To Position/Business Name of Firm Type of Business
Telephone Number Supervisor Reason for Leaving
( )
Have you or any business in which you have been principal owner, officer or director ever failed in business, filed for bankruptcy or compromised
your creditors? NO YES If YES, please complete below.
Have you every been bonded? NO YES If YES, by which employer?
Has your bond ever been revoked? NO YES If YES, explain.
Have you ever been convicted of a crime? NO YES If YES, when and for what?
Are there any lawsuits pending against you? NO YES If YES, provide details.
Are you an endorser or guarantor on any bills or notes, mortgages, bonds, etc. or others? NO YES If YES, what is this total: $
Bank References
Bank Individual City/State/Zip Code Telephone Number
1
( )
2
( )
Application for Nissan Dealer Sales and Service Agreement 2 of 7
NISSAN NORTH AMERICA, INC.
Personal References (Other than present employees or relatives)
Name Address/Telephone Number Occupation Years Known
1
2
Proposed Investment
How much more are you prepared to invest in the dealership? $
By what date will this amount be available?
Will any of your investment require liquidation of assets?
NO YES If YES, show detail in Statement of Assets and Source of Funds section.
Will any funds you plan to invest be borrowed or otherwise encumbered?
NO YES If YES, show detail in Statement of Assets and Source of Funds section.
Will there be additional investors in the proposed dealership?
NO YES If YES, complete the section below.
Investor Name % of
Interest
Amount of
Investment
Title Portion of Investment
Owned Borrowed
% Active in
Business
1
2
3
Additional investors must also complete a Nissan application.
Do any of the investors have a financial interest in any other automobile dealership?
NO YES If YES, complete the section below.
Investor Name Dealership Name City/State Lines Handled % Interest
1
2
Proposed Dealership
The proposed dealership entity will be Corporation Partnership Holding Company
Will you actively manage the proposed dealership? NO YES If NO, whom do you propose:
Name
Home Address
Attach an application from the proposed manager.
Will this individual have ownership?
NO YES
If YES, what percentage
%
Do you propose to operate in an existing facility?
NO YES
If YES, state exact location.
Would you sign a written agreement to remedy and correct any inadequacies in the proposed
facility?
Is the facility
NO YES Owned Leased
If owned, annual mortgage &
mortgage holder name
If leased, annual rent & lessor name Lease expiration date Period of renewal option
$ ; $ ;
Will the proposed facility be an exclusive Nissan dealership? NO YES
Application for Nissan Dealer Sales and Service Agreement 3 of 7
NISSAN NORTH AMERICA, INC.
Financial Information
Please fill in all the blanks and round to the nearest thousand. Write “None” where applicable.
Current as of
/
/
Current Assets (One year or less) Current Liabilities (One year or less)
Cash on Hand $ ,000
Accounts and Notes Payable $ ,000
Cash in Bank (Schedule #1) $ ,000
Installment Accounts (Schedule #5) $ ,000
Public Stocks and Bonds (Schedule #2) $ ,000
Income Tax Liabilities $ ,000
Accounts and Notes Receivable $ ,000
Other Current Liabilities $ ,000
Other Current Assets $ ,000
Total Current Assets $0 Total Current Liabilities $0
Other Assets (Greater than one year) Long Term Liabilities (Greater than one year)
Stocks in Closely Held Corporations
(Schedule #3)
$ ,000
Accounts and Notes Payable
(Schedule #5)
$ ,000
Accounts and Notes Receivable $ ,000
Mortgages (Schedule #4) $ ,000
Real Estate Investments (Schedule #4) $ ,000
Other Long Term Liabilities $ ,000
Pensions, IRA’s, etc. $ ,000
Total Long Term Liabilities $0
Life Insurance (Cash Value) $ ,000
Miscellaneous Assets (Schedule #6) $ ,000
TOTAL LIABILITIES $0
Total Other Assets $0 PERSONAL NET WORTH $0
TOTAL ASSETS $0 TOTAL LIABILITIES AND NET WORTH $0
Annual Income Contingent Liabilities
Salary $
As Endorser, Co-maker or Guarantor $
Bonus & Commissions $
On Leases or Contracts $
Dividends $
Legal Claims $
Real Estate $
Provision for Federal Income Taxes $
Other Income
(Please explain on a separate sheet)
$
Other Special Debt $
TOTAL $0 TOTAL $0
Application for Nissan Dealer Sales and Service Agreement 4 of 7
NISSAN NORTH AMERICA, INC.
Personal Financial Schedules
Schedule #1 — Bank Accounts For each account listed, include copies of bank statements confirming current balance and
systematic deposits for last six months or bank letter verifying such deposits.
Name of Bank Address
Account # Date A/C Opened Current Balance Contact Person Telephone Number
( )
Name of Bank Address
Account # Date A/C Opened Current Balance Contact Person Telephone Number
( )
Schedule #2 — Public Traded Stocks and Bonds For each investment listed, include copies of stocks and bonds,
current brokerage statements or other documentation to verify assets.
Name of Company Description (Preferred/Common) Number of Shares
Date of Purchase Purchase Price Current Market Value Brokerage Firm
Name of Company Description (Preferred/Common) Number of Shares
Date of Purchase Purchase Price Current Market Value Brokerage Firm
Schedule #3 — Stocks in Closely Held Corporation Include appropriate documentation to verify below listed assets.
Name of Company Type of Business % Ownership
Net Worth of Business Date of Purchase Purchase Price Current Market Value
Name of Company Type of Business % Ownership
Net Worth of Business Date of Purchase Purchase Price Current Market Value
Schedule #4. Real Estate Investments and Related Liabilities. Include documentation indicating ownership and current
market value.
Description and Type of Property Location % of Ownership
Net Worth of Business Date of Purchase Purchase Price Current Market Value
Description and Type of Property Location % of Ownership
Net Worth of Business Date of Purchase Purchase Price Current Market Value
Schedule #5 — Long Term Obligations and Installment Accounts
Name of Lender Location Security Collateral
Maturity Date Terms and Covenants Payoff Schedule Outstanding Balance
Name of Lender Location Security Collateral
Maturity Date Terms and Covenants Payoff Schedule Outstanding Balance
Schedule #6 — Miscellaneous Assets. Include appropriate documentation to verify assets.
Description of Miscellaneous Assets Location
% Ownership Date of Purchase Purchase Price Current Market Value
Description of Miscellaneous Assets Location
% Ownership Date of Purchase Purchase Price Current Market Value
Application for Nissan Dealer Sales and Service Agreement 5 of 7
NISSAN NORTH AMERICA, INC.
Applicant’s Source of Funds Statement
In connection with and in support of my application for a Nissan Dealer Sales & Service Agreement, I hereby furnish the
following true and accurate statement of my personal financial assets and the specific source of funds which I intend to utilize,
if approved, to acquire a % ownership interest in (Proposed Firm Na me), a proposed dealership located in , (City,
State):
Detailed Description of Each of My
Principal Assets (Show Present
Location)
(A) Current Value
Prior to Investment
(B) Amount of
Encumbrances to Column (A)
(C) Amount to be Invested
Personally in Dealership
$ $ $
1.
2.
3.
4.
5.
6.
7,
8.
9.
10.
11.
12.
13.
14.
TOTAL ABOVE
$ 0. $ 0. $ 0.
Explain Source of Cash in Excess of $5,000
Include certificates of deposit and other short term notes.
Application for Nissan Dealer Sales and Service Agreement 6 of 7
NISSAN NORTH AMERICA, INC.
The printed representations and understandings set forth on my application form are hereby made applicable to this statement.
Permission is hereby expressly granted to Nissan North America, Inc. to verify the present status of the listed assets and
encumbrances directly with the source listed. Any material change in the foregoing financial data, which would materially
affect my funds to be invested in this dealership will be immediately reported by me to Nissan North America, Inc.
For the purpose of securing credit and other considerations, the undersigned furnishes the above information and Financial
Statement, which fully and truly sets forth his/her financial condition on the day of , .
The undersigned acknowledges and agrees:
1. This application form has been supplied to him/her as a convenience only, and Nissan North America, Inc. shall not incur
any obligation or liability by receipt of this application.
2. No one other than the President or an authorized Vice President of Nissan North America, Inc. has the authority to approve
the undersigned’s application for a Nissan Dealer Sales & Service Agreement. Final approval will be upon the execution of
the Nissan Dealer Sales & Service Agreement by any one of the above named officers.
3. Any misrepresentation or omission, whether intentional or unintentional, in the information supplied by the applicant in this
form shall be grounds upon which Nissan North America, Inc. may immediately terminate any Nissan Dealer Sales &
Service Agreement entered into subsequently with the applicant.
4. The applicant for a Nissan Dealer Sales & Service Agreement hereby authorizes Nissan North America, Inc. to conduct all
reasonable inquiries, investigate or verify personal resumes and financial data and other representations made by the
undersigned.
Signature
Date
Application for Nissan Dealer Sales and Service Agreement 7 of 7
