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Contestant
Application
a.
Completed application form
(including the signed name and likeness release). b.
A passport-size photo. c.
90 second videotape labeled
clearly with your name and phone number. d.
Written family doctors
consent Tape
Deadline: Interviews: July 2003 (time will be confirmed with you directly if you are selected
for an interview). The
producers will contact only those selected for the interview process.
No phone calls please. Send your completed
application and videotape (with no other enclosed items) to the following
address: A301 – PERSONAL
INFORMATION 1)
First Name:
2)
Last Name:
3)
Nickname (if any):
4)
Street Address:
5)
City:
6)
Province:
Postal Code:
7)
Phone Number (home):
(work):
8)
Fax Number:
E-Mail:
9)
If you don’t have an email
address, tell us why:
10)
Gender (please circle): M /
F 11)
Age:
Date of Birth:
12)
Drivers License (for record
check):
13)
Social Insurance Number (for
record check):
14)
Height and weight:
15)
Do you have a home page on
the internet? If so, what is
the address?
16)
Marital Status/Significant
Other: Single? Widowed?
17)
Married? If so, how many
times?
18)
Boyfriend/Girlfriend (name)?
19)
If you have children, please
list their names and ages (please list any step children too):
20)
What is your current
occupation?
21)
Are you a student?
If so, tell us about your major course of study and why you chose
it:
22)
In which other occupations,
if any, have you been employed (please list the last three)?
23)
What is your level of
education and what school(s) did you attend?
24)
Have you had any
particularly interesting occupations in your past?
25)
Have you ever lived with
roommates (circle one)?
YES
NO 26)
Name three of your favorite
hobbies.
27)
Not including your current
place of residence, in which other cities and/or countries have you lived
and for what period of time? Why did you live in each such city or
country?
28)
Do you require special
accommodations or access for handicap? YES
NO (circle one) If
yes, please describe:
29)
Have you been diagnosed as
an adult with a mental illness (es)?
YES
NO (Please circle) If
yes, please describe in detail, citing dates, diagnosis and any on-going
problems:
30)
Have you ever been diagnosed
with, or treated for, alcoholism or any other drug related addiction?
If so, please provide more details, including how long you’ve
been in recovery if that is the case:
31)
Please list any allergies
you have (medications, food, hay fever, dust, etc.) and your current
treatment for them:
32)
Describe your relationship
with your mother:
33)
Describe your relationship
with your father:
34)
Do you have a temper?
How often do you lose your temper?
What provokes you?
35)
How do you deal with anger?
36)
How do you deal with someone
who intimidates you?
37)
When was the last time you
hit, punched, kicked, or threw something in anger?
Please provide details:
38)
List three adjectives that
best describe you: (1)
(2)
(3)
39)
If you could hold any
political office, what would it be and why?
40)
What is the accomplishment
you are most proud of?
41)
Do you have pets? If so,
please list their name and type:
42)
Are you a vegetarian or do
you eat meat?
43)
What is your favorite food?
44)
Do you smoke?
If so, how often?
45)
Do you drink alcohol?
If so, how often?
46)
Have you ever been to a nude
beach? If so, what was it
like?
47)
What is your favorite TV
Show?
48)
What is your favorite movie?
49)
What is your favorite music
to listen to?
50)
List your ten favorite
songs: (1)
(2)
(3)
(4)
(5)
(6)
(7)
(8) |