THE BACHELOR / BACHELORETTE

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1 \ THE BACHELOR / BACHELORETTE Today s Date: Name: Do you have a nickname and where does it come from? Address (Street, City, State, Zip Code): What is the next big city near you and how far is it: Cell# Work # Home # Height: Birth Date: Age: Hair Color: Eye Color: Weight: Do you have a valid U.S. passport? How did you hear about our search? Have you ever applied for the show before? If so, when? ATTN: Are you currently: Working Full Time Working Part Time Unemployed Student Occupation: Annual salary: Page 1 of 6

2 What is your highest level of education? Degree(s): School(s) Attended: Are you a legal resident of the United States? If not, where are you a legal resident? Where were you born? Where did you grow up? Do you have siblings? How old are they? Have you ever been arrested, charged or convicted of a crime of any type? If so, please give details and dates: Have you ever had a temporary restraining order issued against someone or had one issued against you? If so, please give details and dates: Have you ever filed for bankruptcy or chapter 11? If yes, please explain. Page 2 of 6

3 Have you ever auditioned for or been a performer, participant or contestant on a reality or other TV or radio show or in a film? If yes, please explain and give dates: Do you drink alcoholic beverages? What s your favorite drink? Have you ever been married or engaged? If yes, how many times? Please list wedding date(s). If you have been married, why are you no longer together? List the date when such marriage(s) were legally dissolved: Do you have any children? If yes, please list their names and ages and whether they live with you or not. Are you genuinely looking to get married & why? Why would you want to find your spouse on our TV show? Page 3 of 6

4 Please describe your ideal mate in terms of physical attraction and in terms of personality attraction. How many serious relationships have you been in and how long were they? What happened to end those relationships? What are your hobbies and interests? Do you have any pets? Do you have any special talents? Tell us! Do you speak any languages besides English? List 3 adjectives that would surprise people about you: Page 4 of 6

5 Do you have any tattoos? If yes, what are they? And where are they located on your body? What accomplishment are you most proud of? What have you not found but would like to have in a relationship? Page 5 of 6

6 All participants must provide the following when submitting the Participant Questionnaire; failure to do so will result in delaying the processing of your Participant Questionnaire and/or may result in eliminating you from further consideration: Recent Photographs - please submit anywhere from 5 to 15 pictures. Be sure to include some good close-ups shots and full body pics. There is no need to crop out other people. This questionnaire and any other material submitted by me, including, but not limited to, pictures, film and videotapes, becomes the property of NZK Productions, Inc., shall not be returned and may be used in any manner in all media, worldwide, in perpetuity. I further understand that by submitting this questionnaire, Producer has no obligation to accept me and my selection and participation in The Bachelor(ette) is in no way guaranteed, as this questionnaire is merely for the purpose of evaluating potential participants. I acknowledge that I have read and fulfill the eligibility requirements and all the information provided on this questionnaire is true and accurate and any false or misleading information submitted herein is grounds for my immediate elimination from consideration. Signature: Date: Mail the application, photos, and videotape of yourself telling us why you should be on the show to the following address: (photos and videotapes will not be returned) THE BACHELOR CASTING SANTA MONICA BLVD #595 LOS ANGELES, CA Page 6 of 6

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