PROFESSIONAL NETWORK APPLICATION

Applicant Name

PrefixFirst NameMiddle NameLast NameSuffix

Applicant SSN

000-00-0000

Applicant Email

example@example.com

Applicant Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Applicant Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Applicant Current Title

Applicant Company Name

ACME, Inc.

Applicant Company Registered Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Applicant Company Website

Please enter Company Website URL

Applicant Company Annual Revenue

Applicant Company EIN

00-0000000

Applicant Businesses Owned

Rows	Entity Name	% Owned	Year Founded	Year Stock Owned	Currently Owned?	Entity Reg. City, State, Country	Majority Owner?	Title
Entity A
Entity B
Entity C
Entity D
Entity E

Applicant Estimated Net Worth

Individual Only

Applicant Est. Annual Income

INDIVIDUAL

Which NETWORK are you applying to?

Attach Latest Resume

Applicant Professional LinkedIn

Education Background

Rows	School Name	Field of Study	Degree Obtained? Yes/No	Year Started	Year Ended	City, State
High School / Preparatory school
College / University / Undergrad
Graduate School
PHD / JD / MD / etc.

Work History

Rows	Company Name	Title	Reason for Leaving?	Year Started	Year Ended	City, State
Current Company
Previous Company
Company Prior

Professional References

Rows	Reference Full Name	Current Employer	Relationship?	Years Known	Email	Phone #
Reference 1
Reference 2
Reference 3

Background Check

Rows	Yes	No	Other
Have you ever been convicted of, or pleaded guilty or no contest to, a felony?
Have you ever been convicted of a misdemeanor involving fraud, theft, embezzlement, forgery, bribery, money laundering, identity theft, or another financial crime?
Are you currently under indictment, criminal investigation, or awaiting trial for any offense involving financial misconduct?
Have you ever been barred, suspended, or prohibited from participating in any regulated financial industry?
Have you ever been subject to a regulatory enforcement action by a government agency?
Have you ever been permanently or temporarily disqualified from serving as an officer or director of a company?
Have you ever been found liable in a civil action involving fraud, breach of fiduciary duty, or financial misconduct?
Have you ever filed for personal or business bankruptcy? (Only if relevant and lawful for the position.)
Have you ever been the subject of an SEC, FINRA, FTC, state securities, or banking enforcement action? (Adjust for your industry.)
Have you ever had a professional license revoked or suspended?

Business and fiduciary questions

Rows	Yes	No	Other
Have you ever been removed as a director, officer, trustee, or partner for misconduct?
Have you ever been found to have breached a fiduciary duty?
Have you ever defaulted on a business loan due to fraud or intentional misconduct?
Have you ever been prohibited from managing or owning a business?

Litigation questions

Rows	Yes	No	Other
Are you currently a party to litigation involving allegations of fraud or financial misconduct?
Have you ever been found liable for fraud, embezzlement, conversion, misappropriation, or breach of trust?
Have you ever been ordered by a court to pay restitution for financial wrongdoing?

Compliance questions

Rows	Yes	No	Other
Have you ever knowingly violated anti-money laundering (AML) laws?
Have you ever knowingly violated sanctions laws or export control regulations?
Have you ever knowingly submitted false information to a government agency?
Have you ever knowingly falsified financial records or accounting information?

Disclosure and certification

Rows	Yes	No
Are all of your responses true and complete?
Do you authorize us to verify the information provided through background checks, employment verification, and public records, where permitted by law?
Do you understand that providing false or misleading information may result in denial of membership, employment, or termination?

By checking the box below and submitting this application, I certify that all information provided is true, accurate, complete, and current to the best of my knowledge. I understand that any false, misleading, or omitted information may result in the denial, suspension, or termination of my application, membership, certification, or any related services.I authorize American Business Capital Group, Inc. and its affiliated companies, agents, contractors, and third-party service providers to verify the information provided through lawful means, including but not limited to identity verification, employment verification, business verification, professional license verification, financial verification, accreditation verification, reference checks, public records, and background screening where permitted by applicable law.I acknowledge that submission of this application does not guarantee acceptance, approval, certification, membership, investment opportunities, funding, or any other services. I further certify that I have read and agree to the applicable Terms of Use, Privacy Policy, and all program requirements.

PROFESSIONAL NETWORK APPLICATION

General Information

Company / Business Information

Individual Net Worth Verification

Network Information

Resume + Social Media

SCREENING QUESTIONS