Casting Form- Dating Show

1
Full Name* This field is required.
First Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Email* This field is required.
example@example.com
Confirm Email
4
Phone Number* This field is required.
5
Birth Date* This field is required.
Month
Day
Year
6
Appearance* This field is required.
Please Select
Please Select
Male
Female
Other
Gender
Height
Weight
Please Select
Please Select
Asian
Black/African
Caucasian
East Indian
Latino/Hispanic
Middle Eastern
Native American
Other
Pacific Islander
Ethnicity
7
More About You* This field is required.
Please Select
Please Select
Single
Married
Divorced
Engaged
Dating
Widow
Multiple Relationships
It's Complicated (Please explain in Bio)
Relationship Status
Please Select
Please Select
None/Other
Accountant
Actor
Admin - Clerical
Admin Director (College)
Ad Sales
Airline Pilot
App Designer
Architect
Automotive
Baker
Banking
Barista
Bartender
Biotech
Blacksmith
Blogger
Bus Driver
Business Development
Butcher
Cab Driver
Car Sales
Cheerleader
Chef
Chiropractor
Coach (High School)
Coach (Pro Athletes)
College Professor
Construction
Consultant
Customer Service
Dancer
Data Entry
Design
Dishwasher
Distribution -Shipping
Doctor
Dog Groomer
Dog Trainer
Dog Walker
Education
Engineering
Entertainment
Entry level
Executive
EX-Pro Athlete
Facilities
Farmer
Fashion Designer
Fast Food Worker
Finance
Fire Fighter
Fisherman
Flight Attendant
Food delivery
Franchise
Funeral Business
General Business
General Labor
Government
Government - Federal
Grocery
Hair Stylist
Health Care
Hedge Fund Mgr
Hospitality - Hotel
Human Resources
Information Technology
Installation -Maint -Repair
Insurance
Interior Decorator
Inventory
Iron Cast
Jewlery Designer
Journalist
Lawyer
Legal Admin
Management
Manufacturing
Marketing
Media - Journalism - Newspaper
Meteorologist (TV)
Model
Musician
News Anchor
News Reporter
Nonprofit - Social Services
Nurse
Pageant Girl
Pharmaceutical
Photographer
Pilot
Plumber
Police Officer
Professional Services
Professor
Psychologist
Purchasing - Procurement
Quality Control
Radio Personality
Rancher
Real Estate
Real Estate Development
Real Estate Sales
Research
Restaurant - Food Service
Retail
Retail Sales
Retail Store Owner
Sales
Scientist
Server
Singer
Skilled Labor - Trades
Social Worker
Stock Broker
Strategy - Planning
Student (even if you have P/T job)
Supply Chain
Taxi Driver
Teacher
Telecommunications
Training
Train Operator
Transportation
Travel Agent
Truck Driver
TV Reporter
TV Sports Reporter
Veterinarian
Veterinarian Assistant
Veterinary Services
Video Game Designer
Warehouse
Warehouse Manager
Warehouse Worker
Web Site Designer
Website Developer
YouTuber
Occupation
Associates Degree
Bachelor Degree
In College
Trade School Certificate
Graduate Degree
High School Diploma
G.E.D.
J.D.
MD
PhD
Education Degree
Please Select
Please Select
Rent
Own
Living with Parents
Living with Friend
Living with Partner
Homeless
Living Status
Facebook Handle
Instagram Handle
Please Select
Please Select
Straight (Heterosexual)
Gay
Lesbian
Bisexual
Asexual
Pansexual
Queer
Fluid
Aromantic
Bi-curious
Prefer not to disclose
Which of the following best describes how you identify?
8
Tell us about your personality - best & worst traits! * This field is required.
Huge
Large
Normal
Small
Ok
Ok
9
Tell us a bit about your background (where you grew up, family, school, etc.)* This field is required.
Huge
Large
Normal
Small
Ok
Ok
10
Describe your relationship history:* This field is required.
Huge
Large
Normal
Small
Ok
Ok
11
Do you have a super addictive behavior issue that is just getting worse? You know it's a bad habit, but you just don't care.* This field is required.If yes, please explain the addiction: ex. Controlling, Sex, Social Media, Shopping, Online Dating, Partying, etc.
Huge
Large
Normal
Small
Ok
Ok
12
What do you hope to gain from this experience?* This field is required.Please explain your dreams and goals in life:
Huge
Large
Normal
Small
Ok
Ok
13
Have you ever been convicted of a crime?* This field is required.
Please Select
Please Select
Yes
No
If yes, please explain:
14
Have you ever served time in a jail or prison?* This field is required.
Please Select
Please Select
Yes
No
If yes, please explain:
15
Are you a Religious or Spiritual person?* This field is required.
Please Select
Please Select
Yes
No
If yes, please explain your beliefs:
If no, are you open to the idea of learning?
16
Have you ever been on TV before?* This field is required.If yes, please explain below shows and networks:
17
Submit Your Pictures (Head-Shot and Full Body)* This field is required.You can choose to submit any photo you would like us to see. Please just make sure you include 2 headshots and a full body.
Drag and drop files here
Select files to upload
Please ensure your image is less than 5MB and in one of the following file formats : png, jpeg, jpg, gif
Cancelof
18
Submit Your VideoOptional. Submit a video of yourself. This will help us get to see your fun personality and your fit into our new program.
Drag and drop files here
Select files to upload
Please ensure your video is less than 50MB and in one of the following file formats : mpg, mpeg, avi, mp4, wmv, mov, 3gp, mkv
Cancelof
19
Confidentiality and Non-Disclosure Agreement* This field is required.
20
By signing below, I understand that it constitutes a legal signature confirming that I acknowledge and agree to the above Confidentiality and Non-Disclosure Agreement. * This field is required.Sign your name below:
Should be Empty: