Thank you for showing interest in dating Kevineb. In order to help the selection process work efficiently, please fill out the following application.
Application for Dating Consideration(Form A-2.2)Name: __________________
Phone #: ________________
Address: ________________
Age: ___________________
[Attach photo of applicant here]
[Attach photo of applicant's mother here]
Height: _______
Weight: _______
Hair Color: ______
Eye Color: _______
Gender: _________
Have you always been a member of that gender: _______
(Please note: ALL MALES are automatically disqualified!)What type of relationship are you seeking:
___ A) Buddies
___ B) Casual Dating
___ C) Committed Relationship
___ D) Strictly Physical / Booty Call
___ E) Friends With Benefits
(If "YES" to Friends With Benefits, complete and attach the original white copy of FWB Terms & Conditions {Form B-1.0}. Retain the yellow copy for your own records.)___ F) You've already sent wedding invitations to your relatives.
(If "YES" regarding invitations, please tear up this application and never speak to Kevineb again.)Current Occupation: ___________ Intended Career Field: ________
Are you currently attending college: _____
Course of study: ________________ GPA: _____
Select your current educational status:
___ High School Graduate
___ Some College
___ Associate's Degree
___ Bachelor's
___ Master's
___ PHD
Have you ever been diagnosed with or treated for any type of mental disorder: ____
If YES, please explain: _______________________________
Has anybody in your family been diagnosed with any type of mental disorder: ____
If YES, please explain: _______________________________
List all prescription medications you are currently taking, what they are for, and how long you have been using them: _____________________________________________________
_____________________________________________________
_____________________________________________________
Have you, or either of your parents spent time in jail: ____
If YES, please explain: _____________________________________
Do you have any tattoos: _____
If YES, please explain what they are, where they are located, and what you were thinking: _________________________________
Where do you live:
___ A) Alone
___ B) With parent(s) or other guardian(s). Why: ________________
___ C) With other family. Explain: ____________________
___ D) With roommates
Is your roommate hot? ____
[Attach photo of roommate(s) here]
Names of the last three (3) guys you dated, time period of the relationship, and reason the relationship ended:
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Are you in fact SINGLE and not currently in any other relationship, legally or emotionally: _______
Do you have any children (Give names and ages.)
_________________________________________________
How many cats do you have: ________________________
Do you attend all of your church meetings: _______
Even if your friends don't go: _______
Are you worthy of a Temple Recommend: ______
Do you speak with a legitimate foreign accent (Non-USA): _____
If YES, from where: _________________________
What type(s) of music do you usually listen to:
___________________________________________________
Have you ever heard of Dream Theater, Porcupine Tree or Nightwish:
___________________________________________________
Do you have a problem with listening to my music in the car:
___________________________________________________
Do you acknowledge that I (
Kevineb) will likely make fun of the lower forms of music that you (the applicant) listen to: ____________
List the "reality type" or "elimination type" of shows that you watch: (i.e. Survivor, American Idol, America's Next Top Model, etc.) *
____________________________________________________
____________________________________________________
List your hobbies / interests:
___________________________________________________
___________________________________________________
Do you believe in love at first sight:
___________________________________________________
Do you believe relationships continue "happily ever after" like in the fairy tales:
___________________________________________________
Do you often fall head over heals in love with guys you hardly know:
___________________________________________________
Do you have a car: ____ What make/model: _____________
Did you pay for it yourself: ____ If not, who bought it: ________
When did you get the oil changed last: ____________
How often do you talk on the phone while you drive: _________
Do you ever text while you drive: _____
What is your credit rating: _______
List all debts you currently owe and their outstanding balances, including all student loans, credit cards, car payments, etc:
___________________________________________________
___________________________________________________
If a guy made a risqué joke, you would: (Select all that apply.)
___ A) Slap him
___ B) Call him to repentance
___ C) Giggle and blush
___ D) Laugh
___ E) Come back with a joke of your own
___ F) Miss the joke altogether
___ G) Think he is a pervert
___ H) Take him seriously
___ I) Other: _____________________________
On Valentine's Day what do you expect a guy to do:
(Select all that apply.)
___ A) Simply remember and give you a kiss
___ B) Get you a card and maybe some chocolates
___ C) Take you to the most expensive restaurant in town
___ D) Buy you a new car
___ E) Propose marriage
___ F) Rearrange the stars in the sky to form a portrait of you, then hold the Earth still while you look at it.
___ G) What's Valentine's Day?
___ H) Other: _____________________________
On a warm sunny day what would you do: (Select all that apply.)
___ A) Go for a walk / jog / bike ride
___ B) Go swimming
___ C) Play outdoor sports (baseball, basketball, Frisbee, etc)
___ D) Go to the mall
___ E) Play video games
___ F) Sleep all day
___ G) Balance the checkbook
___ H) Get drunk
___ I) Hunt gators in the swamp with your cousin
___ J) Other: ______________________________
What makes you interested in
Kevineb: (Select all that apply.)
___ A) His looks
___ B) His personality / sense of humor
___ C) Cyclists are sexy
___ D) You find him intriguing / mysterious
___ E) Bald guys turn you on
___ F) He has a pulse
___ G) Your friends dared you
___ H) Your baby needs a daddy
___ I) Your therapist said you should meet new people
___ J) You've got a weakness for geeks
___ K) You want a guy to buy you stuff
___ L) You like Progressive Rock music
___ M) You lost a bet
___ N) Who's Kevineb?
___ O) He's single and that's good enough for you
___ P) Other: ____________________________
___ Q) Other: ____________________________
___ R) Other: _____________________________
(If you need more space, please feel free to continue your list on the back of this form.)
Please give the name, address, and phone number for three (3) references.
(TIP: Naming your cat as a reference will result in immediate disqualification.)
__________________________________________________
__________________________________________________
I, the above-named applicant, do hereby acknowledge that the information given in this application is true and correct. I also acknowledge that the submission of this application does not guarantee approval for any type of relationship,expressed or implied, and any relationship that may develop is not a guarantee of a long term commitment.
* I, the applicant, do also acknowledge that naming ANY reality or elimination type shows on the above question on this form is grounds for immediate disqualification. The only possible exception is So You Think You Can Dance which is only acceptable for viewing because of the hot girls and must be watched with the volume muted except during the actual performances.
Signature: ______________________________ Date: ___________
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