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: Basic Information

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.
1

Section 4: Getting to Know You

Highest 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?

If yes, list their names and ages. ____________________________________________

Whats your all-time favorite movie? ______________________________________________
Ive 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

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

If yes, what is it? ________________________________________________________

Your thoughts on time travel? ____________________________________________________
What kind of car do you currently drive? ___________________________________________
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.
____________________________________________________________________________
____________________________________________________________________________
2

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: __________________________________

For more information or for help submitting your application, visit http://aredletterday.blogspot.com