Application for Relationship with Lori__(Last name withheld).
Date __/__/2006
1.) Have you ever committed a felony? _Yes or_No
2.) Have you ever been married? _Yes or _No If Yes, what was the reason? ____________________________________________
3.) Are you on parole? _Yes or_ No If Yes, how long are you on parole and what was the reason?____________________________________________________________________________________________________
4.) Are you employed? _Yes or _No If yes, how long have you worked at your current job? __Weeks __Months __Years
If No, why are you unemployed? _____________________________________________________
5.) Do you have any children? _Yes or _No If Yes, do they live with you? _Yes or _No If No, why do they not live with you?_________________________________________________
______________________________________________________
6.) Do you do drugs? _Yes or _No If Yes, which drug(s) and how often do you use them? _________________________________
7.) Are you often violent? (fight(s) within the last 6 months) _Yes or _No If Yes, when was the last fight and what was it about?_________________________________________________
____________________________________________________
8.)Did your last relationship end badly? _Yes or_ No If Yes, why did it end badly and who broke up with whom?________________________________________________
______________________________________________________
______________________________________________________ May I contact your ex-girlfriend? _Yes or _No If No, why?__________________________________________________
_____________________________________________________
9.) Would you be willing to have a background check done? _Yes or _No If No, what is your reason?______________________________________________
_______________________________________________________
10.) Do you have any sexually transmitted diseases? _Yes or _No If Yes, what disease(s)?_____________________________________________
_____________________________________________________
If No, would you be willing to get tested and show proof BEFORE entering this relationship? _Yes or _No
11.) When in this relationship, will you be completely faithful and forthcoming to all other females that you are, in fact, seeing someone and are completely unavailable to any and all advances?_Yes or _No
***Note: this includes having pictures of Lori__(Last name withheld). _____ and information about said relationship made available to the public.
12.) Do you live alone? _Yes or_No If Yes, How long have you lived there? ___Weeks___Months___Years Is it an __Apartment __House __Van (down by the river)? If No, Do you live with __Parents__Roomates__Ex-Girlfriend/Boyfriend__Other Family
13.) Do you own your own vehicle? __Yes or __No
14.) Do you have any Personal References? __Yes or __No
1.Name-______________City/State_________________Phone__________
2.Name-______________City/State_________________Phone__________
3.Name-______________City/State_________________Phone__________
By entering in the information on this application _______________concurs that everything is completely true and is willing to become a proper boyfriend/lover/possible husband with ONLY ___Lori__(Last name withheld).
Disclaimer:
No single answer will get you passed over, but one lie will.
