boyfriend/girlfriend application, spring 2005

*Please note: Falsification or misrepresentation of information will result in immediate disqualification.   I do not discriminate.  Feel free to email me at josiedoesntshare@yahoo.com and correspond with me before filling out all application materials.


Basic Information

all sections in Basic Info must be completed

First name:

Last name:

Middle initial:

Height: feet, inches

Weight: pounds

Birthdate: (in 19xx format please)

Birth time: and

City of birth:

State of birth (if USA; if not, please indicate country instead):

Sex:
Male
Female

Gender:
Male
Female


More About You ...

Current street address:

City:

State (abbreviation):

Zip code:

Check all that apply.*
I smoke cigarettes on a regular basis.
I drink alcohol on a regular basis.
I use recreational drugs.
I have been convicted of a felony.
*note: checks in these boxes will not necessarily disqualify you.

Do you have your high school diploma or equivalent?
Yes
No

Choose your 'occupation':

What is your current major (or, if not a student, previous or potential major)?

Where and in what capacity are you currently employed (or, if not employed at the moment, state last job):

Current relationship status:

Projected relationship status for:

Next month:

Next year:

Five years from now:

Position desired:


Personal History

Have you had a significant and/or long-term relationship before?
Yes
No

If yes, how many?

If yes, why did you and your most recent significant other break up?

If no, why not?

Have you ever cheated on a girlfriend?
Yes
No


Personal Statements

Complete at least four of the five questions.

What is the nature of the position you are applying for, and how will this fit into your life at the moment?


Why are you applying for this position?


What do you feel are your greatest talents/assets, and why?


What is your favorite thing about women (me in particular)?


What are your greatest aspirations or plans?



References

1. Full name
 Relationship to applicant
 Phone number

2. Full name
 Relationship to applicant
 Phone number

3. Full name
 Relationship to applicant
 Phone number


Contact Information

Fill out all fields. Please indicate the easiest way to contact you:
Phone
Email

Preferred name or nickname:

Phone or pager number:

Email address:


AIM screenname:


Thanks!