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Empretec Program application form - Dedicated Servers, Managed

By Pauline Barnes,2014-07-09 12:01
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Empretec Program application form - Dedicated Servers, Managed ...

    Entrepreneurship Training Workshop Application Form

    Applicant’s Name:_____________________________________________________ For Course Date:____________

PART I: Applicant’s Background

    1) Contact Information

    Q1 Please insert today’s date

Q2 Applicant’s First and Surname

    Q3 Sex Please tick Male Female

     ?

    Q4 Home Address

    Please enter your address here (Street/ location, House No. Town)

     Home Telephone

    Mobile Phone

    Email

    Q5 Business Address

    Please enter your physical business address here (Street/ location, Town, Telephone)

     Business Telephone

    Business Fax

    Website of business (if available)

2) Personal Background

    Q6 Please indicate your age

    Family Status Q7 Please tick Never married Married Divorced Widowed

     ?

    3) Educational Background

    Q8 Duration of your education

    How many years of primary education did you do?

     1

    P.O Box 941865 Amman 11194 Jordan

     Tel: (962) 65865002 Fax: (962) 6 5865003 Mob: (962) 79 9088984

     Email: ghijazi@bdc.org.jo www.empretecjordan.org

    How many years of secondary education did you do?

    How many years of tertiary education did you do?

    Q9 Level of your education

    Please indicate all educational levels Please tick Primary Secondary Tertiary Other (Specify)

    from which you received a degree education Education Education

    (multiple options possible) ?

    Please indicate the tertiary (university or

    polytechnic) degree you have received, if any

    (Please indicate the title and study area)

    Q10 Business content of your education

    Please tick Please indicate whether any business-Yes No If Yes, please give details below

    education or business-related content

    was part of your general education ?

    (e.g. accounting, business studies,

    marketing, finance, etc.)

    Q11 Apprenticeship/ Vocational Training

    Please tick Did you do an apprenticeship/ Vocational Yes No

    Training Degree? ?

    Please tick If Yes, please indicate the type of training Apprentice VET Degree Other (Specify)

    ?

    Please indicate in which trade/ subject you did the

    apprenticeship or Vocational Training

4) Your Exposure to Business

    Q12 Parents’ Business

    Please tick Did your father or mother own his/her own Yes No

    business? ?

    Please tick If yes, did you ever help in their business? Yes No

    ? Q13 Relatives’ Business

    Please tick Did any of your relatives besides your Yes No

    father or mother own a business? ?

    Please tick If yes, did you ever help in their business? Yes No

     ? Q14 Were you the first child born in your Please tick Yes No

    family? ? Q15 Have you travelled outside your Please tick Yes No

    country? ?

    If yes, list the three countries where you have travelled most frequently, how many times you have travelled

    to each and the purpose of your travel

     2

    P.O Box 941865 Amman 11194 Jordan

     Tel: (962) 65865002 Fax: (962) 6 5865003 Mob: (962) 79 9088984

     Email: ghijazi@bdc.org.jo www.empretecjordan.org

    Name of Country No. of times travelled Please tick Purpose

    to this country ? Business Tourism

     ?

     ?

     ?

    Q16 Have you subscribed or access Please tick If Yes, please name it: Yes No

     to an (international) business ? journal?

    5) Your Work and Business Experience

    Q17 Please list your past work experience below, with your most recent job first

    Name of employer Please tick the type of Years Title of your position Did you

     worked supervise employer ? here staff? ?

    Private Public Other Yes No

Q18 Are you presently in business for Please tick Yes No

     yourself? ?

    How many businesses do you own in total?

    (Please indicate the number of businesses you own)

    I own and run I only own the I only run the I am employed in Please tick Please provide details on your the business business business the business one major current business

     ?

    I am the only I jointly own Please tick Please indicate Please provide details on the owner the business the number of ownership structure of your ? owners major current business

Q19 What kind of business do you currently

    have? (Please describe your major business)

    What is the annual sales turnover of your business from the previous year? (in US $)

    How many employees do you currently have? Full time Par-time

    What is the value of your current investment? (in US $) Q20 If you are currently not in business, have Please tick If Yes, please indicate Yes No

    you ever started a business in the past? the year ?

     3

    P.O Box 941865 Amman 11194 Jordan

     Tel: (962) 65865002 Fax: (962) 6 5865003 Mob: (962) 79 9088984

     Email: ghijazi@bdc.org.jo www.empretecjordan.org

     What kind of business did you have in the

     past?

    What happened to this business?

6) Your Future Business Plans

    I plan to I plan to expand I have no Other, please specify Q21 Please indicate your Please start a new my existing plans yet future business plans tick business business

    ?

    Please describe your

    plans in more detail

    Q22 If you intend to start-up or expand your business, how much capital do Currency

    you think you would need in total? (Please indicate the currency and the amount)

    Your own money Loans or gifts from Bank loan Other, please Q23 Estimate the amount from family or friends specify: each of the following sources that you can put into starting/

    expanding your business:

    7) Your Motivation

    I always wanted Otherwise I would To make money Other (specify): Q24 What was/ is your major Please tick my own business be unemployed additional to my motivation for starting a only one salary business? ?

    Money Education Friends Motivation Other Q25 Which one of the following Please tick (specify) ingredients needed to succeed in only one

    business do you think is the most ? important?

    Please tick Q26 Do you agree or disagree with the following statement? Agree Disagree

    “It is more important for a job to offer opportunity than security.” ? Q27 Use your imagination and try to think of as many uses as possible for sawdust or products that

    could be made of sawdust

    1. 4.

    2. 5.

    3. 6.

    Q28 Do you agree or disagree with the following statement? Please tick Agree Disagree

    “There are enough opportunities for people like me to start their own business in ? this country.”

     4

    P.O Box 941865 Amman 11194 Jordan

     Tel: (962) 65865002 Fax: (962) 6 5865003 Mob: (962) 79 9088984

     Email: ghijazi@bdc.org.jo www.empretecjordan.org

    Q29 Imagine that your brother or sister has sent you a gift of US$1,000 to spend as you like. What would you do with it?

    First Use.

    Second Use

    Third Use

    Don’t know Average Somewhat Very Q30 How would you describe your desire to start Please tick strong strong a new business or expand your existing only one

    business? ?

    Q31 At this stage, what are the chances of success for your business? (Please tick one answer only ?)

    10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

    Please explain why this is the case below

    Thank you very much for your time!

     5

    P.O Box 941865 Amman 11194 Jordan

     Tel: (962) 65865002 Fax: (962) 6 5865003 Mob: (962) 79 9088984

     Email: ghijazi@bdc.org.jo www.empretecjordan.org

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