The purpose of this application is to collect information from you about your qualifications to assist the Crip. Please feel free to answer as little or as much about yourself as you would like to. Just remember the more you tell me about yourself the better chance I have to see if you are someone for me.

Fill out the information in each section as requested. Then at the end of the form supply your name and contact information, and submit the form. You will receive a confirmation message from me shortly. Send photos to: mailto:bf@cripple.com

Job Application - Work for the Crip

Please identify and describe yourself:

SECTION A -- Basic Statistics

Please fill out the following fields.

Name
Street
City
State
Zip Code
Country
Phone #
Email Address
Homepage
Date Please input 
	Physical Description
Age
Birthdate
Weight
Height
Hair Color
Eye Color
Gender

SECTION B -- Questions!

These are the questions I would ask you if you were her in front of me.
 

Questions Answers
1 What type of music do you like?
2 What kind of movies do you enjoy?
3 Do you like to go to concerts?
4 Do you like to go to parties?
5 Do you like the outdoors?
6 Do you like camping?
7 Do you drink alcohol?
8 Do you smoke?
9 Are you extremely religious (I hope not)?
10 Are you moody?
11 Do you like animals?
12 Do you like being with people?
13 Do you like family gatherings?
14 Can you cook?
15 What foods do you like to eat?
16 Are you concerned about politics?
17 Are you concerned about the environment?
18 Do you have a drivers license?
19 How tall are you and what do you weigh? This relates to whether or not a person can transfer me from the wheelchair to bed and visa versa.
20 Do you have any medical problems?
21 Are you allergic to dogs, cats or anything else?
22 Are you easy to get along with?
23 Would you consider yourself physically strong?
24 Would you consider yourself mentally strong?
25. When could you start working?
26. How long could you stay if you liked the "job?"
27. Have you ever worked a live-in job position before?
28. What is your favorite movie(s)?
29. What is your favorite band(s)?
30. What is your favorite TV show(s) if any?
 

SECTION C -- Free format.

This section is just a chance for you to tell me something about yourself. Tell me and/or ask me anything. It's important for you and I to make the right decision.

Please enter any additional comments regarding the "job" helping the Crip.



 

FORM SUBMISSION

Thank you for taking the time to answer the questions on this application.

The moment I receive your (a serious applicant) information I will get in touch with you.


Bruce Faber
Copyright © 2006 [CrippleScum]. All rights reserved.
Revised: 09/07/06