The Official Girlfriend Application
This application must be filled out in its entirety in order to be considered for the position that you are applying.
Photographs or other attached documents may sway my opinion one way or the other; feel free to attach anything
you think may help you gain this position. Keep in mind that you must be completely honest while filling out this
form. Your answers will be checked through Google, Myspace, Facebook, and other methods I deem necessary.
Any false information gives me the right to immediately void your application.
Section 1: The Basics
Full Name ____________________________________________________________
Last
First
Middle
Current Residence ______________________________________________________
City
Nickname _______________
Eye Color ______
Height ______
State
Zip
Age _____
Natural Hair Color __________
Weight (Circle One) <100 lb
Current Hair Color __________
>100 & <175
>175
Section 2: Contact Information
Home Phone ____________________
Cell Phone _____________________
IM Name (Please specify service, AIM preferred) _____________________
Email __________________________
Section 3: The Deal Breakers
Yes No
Are you or have you ever been a man?
Do you smoke and/or use other tobacco products?
Do you drink heavily on a regular basis?
Do you use any illegal substances?
Do you have any tattoos?
Do you whistle on a regular basis?
Would any of your actions with previous boyfriends be considered not “Beth
Justin Approved”?
Disregarding your ears, do you have any piercings?
Regarding your ears, are they gauged larger than 1/16th of an inch and/or
might they set off metal detectors at airports or government buildings?
Have you ever been convicted of anything by a court of law?
If you answered “Yes” to any of the previous questions, you may stop filling
out the application now as we are not currently interested in your services.
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Section 4: Getting to Know You
Current Level of Education (Circle One) High School Some College College Graduate
What is your religious affiliation? _________________________________________________
What is your political persuasion? _________________________________________________
Could you explain what said persuasion stands for?
Do you have any siblings?
Y
Y
N
N
If yes, list their names and ages. ____________________________________________
What’s your all-time favorite movie? ______________________________________________
I’ve seen: (Circle all that apply) The Matrix Trilogy
Serenity
All 6 Star Wars
Any season of Red vs. Blue
Are you easily distracted by shiny things? Y
N
List your 2 favorite musical genres. _______________________________________________
Favorite sport and team (If any) __________________________________________________
Do you ski / snowboard or would you be willing to learn? Y
Do you currently have a source of income? Y
N
N
If yes, what is it? ________________________________________________________
Your thoughts on time travel? ____________________________________________________
Would the word “expressive” describe your face? Y
N
Section 5: Short Answer
Describe yourself using three to four adjectives and zero to one noun.
____________________________________________________________________________
What is your idea of a perfect date, in three sentences or less?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
What characteristics of mine led you to apply for this position?
____________________________________________________________________________
____________________________________________________________________________
Explain why I should pick you as my girlfriend in one sentence.
____________________________________________________________________________
List any special skills you have that may be relevant to this position.
____________________________________________________________________________
____________________________________________________________________________
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Section 6: Relationship Background
List the details of your past three relationships, starting with the most recent.
Name of Boyfriend:
Start Date:
End Date:
Were you the: (Circle one) Dumper Dumpee
Reason for breakup:
Name of Boyfriend:
Start Date:
End Date:
Were you the: (Circle one) Dumper Dumpee
Reason for breakup:
Name of Boyfriend:
Start Date:
End Date:
Were you the: (Circle one) Dumper Dumpee
Reason for breakup:
Section 7: References
Please Supply three references and their contact information (Phone, IM, and/or Email).
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Section 8: Certification
I hereby certify that the information given by me in this application is true to the best of my
knowledge, and I give you the authorization to verify it using any means deemed appropriate. I
understand that filling out this form and submitting it for review does not guarantee that I will
be chosen. I also understand that my information will not be released to independent 3rd parties
and will only be viewed by the final judge(s).
Date: _____________
Applicant Signature: __________________________________
Please return to your completed application to me by any means deemed convenient.
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