EFTA01142616.pdf

RICHARDEASTON Questionnaire General 1. Full Legal Name: 2. Current Address? 3. Work Phone/Cell Phone 4. Email Address? 5. Drivers License or Passport Number 6. Age/Birthdate? 7. How did you hear about us? Appearance 8. HeightNVeight? 9. Dress Size? 10. Hair Color/Eye Color? 11. Which of these best describes your body type? (Please type letter) a. Thin b. Average c. Athletic d. Other (specify) Employment and Education 12. Please list every school attended after high school and any relevant degrees. 13. What do you do for a living? 14. What was your annual income in the last three years? EFTA01142616  a. 2010 b. 2011 c. 2012 15. What is your net worth? 16. Who is your employer, and what Is your title? 17. How long have you worked there? If less than two years. please specify where you worked before. Lifestyle 18. What do you like to do in your free time? 19. How physically acbve are you? Are you involved in any active sports/athletic activities? If so. how often? 20. What are some of your favorite places? 21. Do you smoke? 22. How often do you drink? 23. Do you have children? If so. how many? 24. Do you want children? 25. How Important is giving birth your own children on a scale of one (low priority) to ten (high priority)? Please explain. 26. Do you have pets? If so, what kind? 27. Do you like pets? If so, are you more of a dog or a cat person? Background & Values 28. What ethnicities best describe you? 29. What is your faith? 30. Do you consider yourself more religious or spiritual? EFTA01142617  31. Do you speak any other languages? 32. Describe your political views? GottIna to know you 33. Relationship Status? (Please type letter) a. Never married b. Separated c. Divorced d. Widow/Widower 34. Are you currently in a relationship? Explain. 35. In the romance department, where would you like to see yourself in 3 years? 36. Where did you grow up? 37. What countries have you visited? 38. Do you have any siblings? If so. what number child are you? 39. What do you consider to be your most valuable attribute? 40. When in a serious relationship, how important is sex and often do you like to have it? 41. Describe your relationship with your mother: 42. Describe your relationship with your father: 43. What do your mother and father do for a living? 44. Axe your parents still married? (If not, how old were you when they divorced. and did they remarry?) 45. Are you currently taking any medications? Please explain. 46. Do you currently have or have you ever had a history of drug abuse? If yes, explain: 47. Have you ever been convicted of either a misdemeanor or felony? If yes, explain: 48. Do you have more male or female friends? 49. What's your favorite movie and why? EFTA01142618  50. What's your favorite book and why? 51. On a first date, are you? A. Hands Off B. Kiss the Cheek C. Go with the Flow D. Touchy Feely Kiss E. Gone with the Wind 52. How emotionally available are you? A Never needed anyone anyway B Fine if they're absolutely perfect C Still looking in the rearview mirror D I've reconciled my past and I'm free E I'm ready. Life is grand. Take me... Getting to know your match 53. How important is your match's height (Please be specific)? 54. Typically, what is your type? 55. What are the top three must haves you want in a life partner? Elaborate. 56. Ethnicity? 57. Religion? 58. Level of Education? 59. Spoken languages? 60. What activities might you enjoy doing with your match? Their Lifestyle 61. Do you have a preference in the field of work he's in? 62. Do you have a preference where he/she resides? 63. Smoker? (Please type letter) a. No b. Occasionally c. Cigars aficionado d. Daily e. No preference EFTA01142619 64. Alcohol? (Please type letter) a. Never b. Moderately c. Social drinker d. Regularly e. No preference 65. MaritaVFamily histm — do you have any concerns/questions? EFTA01142620