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Boyfriend Application Form: Applicant Information

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Boyfriend Application Form

Applicant Information
Birth
Full Name: Date:
Last First Middle

Home
Address:
Street Address Apartment/Unit #

City State ZIP Code


Provincial
Address:
Street Address Apartment/Unit #

City State ZIP Code

Phone: Email

Blood Type: Height: Weight:

Birth Order/ Family


background:

YES NO YES NO
Do you or have tried smoking? Do you drink?

YES NO If yes, how


Do you or have tried prohibited drugs? often?

YES NO
Do you have kids?

If yes, explain
current status:

Education

High School: Address:

YES NO
From: To: Did you graduate? Diploma:

College: Address:

YES NO
From: To: Did you graduate? Degree:

Other: Address:

YES NO
From: To: Did you graduate? Degree:

1
References
Please list three real people that could serve as your references.

Full Name: Relationship:


Company: Phone:
Address:

Full Name: Relationship:


Company: Phone:
Address:

Full Name: Relationship:


Company: Phone:
Address:

Relationship Background
Name of Ex: Citizenship:

Gender: Age: Status:

Period of
Dating
From: To: Reason for Breakup:

YES NO
Were you in love? If yes, how much?

Name of Ex: Citizenship:


Gender: Age: Status:

Did you ever cheat?


Period of Dating
From: To: Reason for Breakup:

N
YES ONO
Were you in love? If yes, how much?

For more than two exes, please use


additional sheet to provide the
information needed.

Reasons I Should Pick You


What is your idea on the purpose of dating?

Why are you applying to become


my boyfriend?

2
What do you want to achieve out
of dating?

Disclaimer and Signature


I certify that my answers are true and complete to the best of my knowledge.
If give you the authorization to verify it using any means deem appropriate, I understand that false or misleading
information in my application does not guarantee I will be chosen.

Signature: Date:

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