License Application

Congratulations on your decision to apply for Licensing a Healthy Boost Kiosk!

License Application

Please keep in mind this is not a job application or a contract. If you're looking for job opportunities, please visit our careers page. On this page, you are simply taking the first step in our License application process.

I am…

A new prospective Licensee interested in licensing a Healthy Boost Kiosk

Basic Qualification Requirements:

At least 21 years old U.S. citizen or permanent resident with a Passion for day-to-day operations Retail, restaurant, operations or management experience

Please provide your contact information
Fields marked with * are mandatory.
Name*
First Middle Last
Mobile No.*
Alternate Number
Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Tell us about yourself
Date of Birth*
Date Format: MM slash DD slash YYYY
Social Security No.*
US Residency Statu*
Are you a U.S. military veteran?
- Yes
- No
Military Status
- Active
- Out Less than 5 years
- Out more than 5 years
- Reserved - National Guard
Area of interest*
Have you ever been employed by Health Boost Inc or at a Health Boost Kiosk?*
- Yes
- No
If you have been employed at Health Boost, please provide your title and description of your duties
If you have been employed at Health Boost, please provide the store address or store number
How many years of retail experience do you have?*
How many years of management experience do you have?*
Describe your experience and qualifications
Describe how you will operate your business
Do you have firing or hiring experience?*
- Yes
- No
Are you able to dedicate full-time managing and working at the Kiosk?*
- Yes
- No
What is the maximum you are able to invest in this business opportunity? (i.e. 401K)*
How much of the investment is liquid? (cash or checking or saving account)*
Will you require financing
- Yes
- No
Will your Spouse or Co-signer be on the Health Boost agreement?
- Yes
- No
Spouse or Co-signer Name
First Middle Last
Spouse or Co-signer Date of Birth
Date Format: MM slash DD slash YYYY
Social Security No.
Resume upload (optional)
Acknowledgment
I/WE recognize that Health Boost, Inc., is not in any way obligated to License a Health Boost KIosk to ME/US because of MY/OUR execution of this document. I/WE acknowledge that any false statement on this application shall be considered sufficient cause to deny any further consideration or cause revocation of any signed agreement with Health Boost, Inc. I/WE understand that any inquiry regarding MY/OUR character, general reputation, personal characteristics, financial background and general fitness for being a Health Boost License may be made as a result of this application. In addition, by signing below I/WE release any and all former and/or present employers, and any other personal or business references, from any liability whatsoever in connection with Health Boost's attempt to investigate MY/OUR background and determine MY/OUR fitness to become a Health Boost License. I/WE specifically authorize Health Boost to obtain credit reports from one or more credit bureaus and background check on ME/US and MY/OUR business(es). A copy of this authorization may be used in place of and shall be valid as the original. I/WE understand that this application is considered active for 180 days from the date below. By submitting this application I/WE agree that this information is correct and I/WE give Health Boost, Inc., permission to obtain a Credit Report and Background Report for the individuals listed on this application. I understand and acknowledge that if I am married but do not provide complete information for myself and my spouse, Health Boost, Inc. cannot process this application.
*
- I/WE Agree
Applicant's Signature*