Big Brother Canada LONG FORM APPLICATION CONTACT INFORMATION First Name____________________Middle_______________________Last_______________________________ Full legal name as it appears on your travel documents is required above Nickname /Aliases / Maiden Names: _____________________________________________________________ Have you ever formally or otherwise changed your name? If so, what other names have you used and why? _____________________________________________________________________________________________ _____________________________________________________________________________________________ Hair Color:_______________________________________ Eye Color:_____________________________________ Address: _______________________________________ Home Phone:__________________________________ City: ___________________________________________ Work Phone:__________________________________ State ( Province ): _________________________________ Mobile: ______________________________________ Zip ( Postal Code ):________________________________ Fax: _________________________________________ Email address: _________________________________________________________________________________ Face book / Twitter / Other: ______________________________________________________________________ In what town / city did you grow up? _______________________________________________________________ What city do you currently reside in? _______________________________________________________________ Closest Airport: ________________________________________________________________________________ Emergency Contact: _________________________________ Phone: _____________________________________ EMPLOYMENT / EDUCATION Highest level of education completed: ____________________________________________________________ What college or University did you attend? ________________________________________________________ Degree(s): ____________________________________________________________________________________ Current Occupation: ___________________________________ How long at current Job? _________________ *Current Employer: _____________________________________________________________________________ If you are a student, what is your major / field of study and what year of study are you currently in? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ PERSONAL 1.What is your marital status? IE: Single, living common-law, married, divorced, separated, widowed, dating. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 2.Do you have any children? If yes, please list their name(s) and age(s). _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Page 1 of 7 3.Which (3) books would you take with you to a deserted island and why? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4.Which television programs do you always watch and why? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5.Which television programs do you never watch? Why not? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6.Do you play a musical instrument? If yes, what instrument do you play? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 7.Are you active in any of the following: Dancing / singing / acting / playing music in a band or orchestra / writing poetry / inventing things / chess / painting / sculpting ? If yes, please describe any achievements in these fields. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 8.Do you have any other creative, artistic or intellectual hobbies? If yes, please explain. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 9.Are you a smoker? If yes, how many cigarettes per day do you smoke? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 10. Do you drink alcohol? If yes, how often, how much per week? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 11. What is your favorite alcoholic drink? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 12. Do you use any drugs? If yes, what and how often? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 13.Do you consider yourself a good cook? ___________________________________________________________ 14.What is your favorite meal? ____________________________________________________________________ 15.Are you a vegetarian? _________________________________________________________________________ 16.What is your favorite color?____________________________________________________________________ 17.Are there any foods you do not eat or are not allowed to eat? What and why not? _____________________________________________________________________________________________ _____________________________________________________________________________________________ Page 2 of 7 18.Do you have any pet(s)? If yes, what kind of pet(s) and what are their name(s)? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 19.What sports do you play? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 20.What sports do you like to watch? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 21.Do you think politics are important? Clearly state why or why not. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 22.If you could become the leader of a political party, which party would that be? Please explain. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 23.Do you think it’s important for people to be religious? Please explain. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 24.Are you a member of any organizations or associations? If yes, please explain. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________