First Name
Last
E-Mail Address
Age
Date of Birth
Month
Day
Year
Last Employer
Time Known year(s)
Orgasms per hour (rate of pay)
Sex? male
female
other
both
tri
?
Personal References:
Name:
Phone#:
Times Satisfied:
Name:
Phone#:
Times Satisfied:
Is this your first time applying here?
If no, state date and place:
Have you ever been convicted of a crime other than a traffic violation?
If yes, type crime and time served:
Give a 1-10 perversion factor (with 1 being lowest and 10 being highest):
Any sexually transmitted diseases? Chlamydia
Genital Warts
Gonorrhea
Herpes
Hepatitis B
HIV/AIDS
Syphillis
None
Position Desired:
Length of cock (if applicable):
Prefered method of Birth Control:
Comments