First Name
Last Name
Age
Weight
Height
Eye Colour
Measurements
Hair Colour
Email Address
Do you smoke?
yes
no
Do you use any illegal substance?
yes
no
Do you have kids?
yes
no
Do you workout?
yes
no
Do you have a history of mental illness?
yes
no
Do you currently have a source of income?
yes
no
If yes, how much is it?
Do you currently live on your own?
yes
no
If no, who do you live with?
What kind of car do you drive?
Level of education
high school
some college
degree
Favourite sport and team
Have you ever cheated on a girlfriend?
yes
no
Do you cook?
yes
no
What is your religion?
How many piercings do you have?
How many tatoos do you have?
What is your current movie of all time?
List three of your favourite type of music
What is your idea of a perfect date?
Why should I pick you as my husband?
List any special skill that you have that are relevant to this position
What do you want out of a relationship, especially one with me?
Who was your ex-girlfriend, how long was the relationship, were you in love and reasons for breaking up
Please supply 3 references and email addresses
I hereby certify that the information given by me in this application is true to my knowledge and I give you the authorization to verify it using any means you deem appropriate. I understand that by filling out this form and submitting it for review does not guarantee that I will be chosen.
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