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Application

Girlfriend Application General Name: Age: Location: Are you employed? [ ] Yes [ ] No Employer: Education Highest Grade Completed: Are you currently enrolled in school? [ ] Yes [ ] No If yes, what is your course of study? Transportation Do you have a reliable form of transportation? [ ] Yes [ ] No Do you own your own car? [ ] Yes [ ] No Do you have a license? [ ] Yes [ ] No Family Do you speak with a majority of your family? [ ] Yes [ ] No Would you sacrifice anything for your family? [ ] Yes [ ] No How often does your family ask you to sacrifice for them? [ ] Never [ ] Sometimes [ ] Often [ ] Weekly History Are you currently in a relationship? [ ] Yes [ ] No Have a majority of your relationships been abusive? [ ] Yes [ ] No Do you speak with any of your ex-boyfriends? [ ] Yes [ ] No If yes, are you “good friends?” [ ] Yes [ ] No How often do you go to the doctor? [ ] Never [ ] Sometimes [ ] Often [ ] Weekly Interests Do you: [ ] Drink [ ] Smoke [ ] Use drugs Of the previous, what brand/kind do you drink/smoke/use? How often? Do you like mushrooms? Are you in the medical field? What kind of music do you listen to? Qualifications Do you have any special qualifications? [ ] Yes [ ] No If yes, explain: Please provide at least two references that are not family members: Name: E-mail: Name: E-mail: All answers are confidential. I understand that I will not be discriminated based on age, race or sexual orientation. This application or follow-up interviews do not constitute a binding contract for a relationship. Until such contract is put into place either party may end communication or involvement for any reason. I understand that no single answer will affect my application status. I hereby affirm that all answers are true, to the best of my knowledge and I have not falsified any information. I understand that falsification of any information on this application could result in termination of contact or involvement. Name_____________________ Date_____________
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16 years ago
Application

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