A Collection of Tears in a Truth Filled Jar

Relationship Application

Name _________________________________________

Reason For Applying ________________________________________________________________________________________________________________________________________________________________

Age _____

Gender _____

Area of Residence (please include state, city, and town) _____________________________________________

Most Traumatic Childhood Experience ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Will You Make Me Fall In Love Then Leave Me? 

Describe Yourself in 5 Words

________________________________________________________________________________

What do you think is your biggest problem in relationships?

________________________________________________________________________________________________________________________________________________________________

Are you capable of admitting to your own mistakes?

Yes                   No

What type of reputation do you have + want to have ? Do you care about it? Do you think it's accurate?

________________________________________________________________________________

Yes                  No 

Yes                 No

Do you believe in (long term) commitment?

Yes               No

Do you think chivalry is dead? (define Chivalry- Chivalry is polite, kind, and unselfish behavior, especially by men toward women)

Yes            No

How many relationships have you been in?

________

Are you looking for a relationship/love or just sex? (It's complicated will result in default disqualification)

_______________________________

Do you know when and how to apologize?

Yes                  No

When will you cheat and ruin me?

What was the reason for your last breakup? (It's complicated will result in default disqualification)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

When were you the reason for a breakup? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What're your views on women?________________________________________________________________________________________________________________________________________________________________

Are you capable of reading body language?

Yes             No

What type of social skills do you have?

________________________________________________________

Have you ever had your heartbroken?

Yes              No

What's something that's happened in your life that's altered who you are?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you like/want kids?

__________________________________________________________

Do you believe in marriage?

Yes              No

Are you still hung up on an ex (answer honestly)?

Yes            No

Are you currently in a relationship?

Yes           No

Are you currently in somewhat of a relationship?

Yes          No

Is there someone who thinks you and him/her are in a relationship?

Yes         No

Give a brief explanation of who you are.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you like animals?

Yes       No

How's your relationship with your parents/guardians?
____________________________________________________________________________________________________________________________

Why can't I let go of what I hoped you'd be?

(Answer not applicable.)