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Speed Dating Screening Form
Thank you for taking the initial step to a fun and memorable speed dating event!
Please accomplish the form below to help us pool the right mix of people and make this engagement as interesting as possible. This shall form part of our screening and selection process to ensure the safety of the participants.
Based on the contact information provided, an event organizer will reach out to you for additional details.
We look forward to seeing you in our event!
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* Indicates required question
Personal Information
1. Full Name
*
Your answer
2. Nickname
*
Your answer
3. Address
*
Your answer
4. Gender
*
Choose
Male
Female
5. Which of the following best describes your current relationship status?
*
Choose
Married
Widowed
Divorced
Separated
Single, in a relationship
Single and available
6. Birthday
*
MM
/
DD
/
YYYY
7. Age
*
Your answer
8. Facebook Page Link
*
Your answer
9. Email Address
*
Your answer
10. Telephone Number
*
Your answer
11. Cellphone Number
*
Your answer
Background
1. Which of the following best describes your current occupation?
*
Community and Social Service Occupations
Education, Training, and Library Occupations
Building and Grounds Cleaning and Maintenance Occupations
Personal Care and Service Occupations
Protective Service Occupations
Computer and Mathematical Occupations
Healthcare Support Occupations
Architecture and Engineering Occupations
Food Preparation and Serving Related Occupations
Business and Financial Operations Occupations
Installation, Maintenance, and Repair Occupations
Legal Occupations
Production Occupations
Construction and Extraction Occupations
Life, Physical, and Social Science Occupations
Healthcare Practitioners and Technical Occupations
Sales and Related Occupations
Management Occupations
Office and Administrative Support Occupations
Arts, Design, Entertainment, Sports, and Media Occupations
Farming, Fishing, and Forestry Occupations
Transportation and Materials Moving Occupations
Other:
2. Which of the following categories best describes your employment status?
*
Choose
Employed, working full-time
Employed, working part-time
Self-Employed/Business
Unemployed
3. Company/Business Name
*
Your answer
4. What is the highest level of school you have completed or the highest degree you have received?
*
Choose
Less than high school degree
High school degree or equivalent
Some college but no degree
Associate degree
Bachelor degree
Graduate degree
5. University/Academic Institution
*
Please state your degree/course, if applicable.
Your answer
Your Qualities
1. Describe yourself in 5 lines.
*
Share something interesting about you (personality, hobbies, passion, etc.).
Your answer
2. What do you consider as your best physical asset/s?
*
Your answer
Qualities You Look For
1. Describe your ideal partner.
*
List down personality, traits, values, etc.
Your answer
2. What attracts you physically to an opposite sex?
*
Your answer
Reasons For Joining
1. Why join a speed dating event?
*
Check all that apply.
Looking for a serious relationship
Marriage
Companionship/Friendship
Finding networks
Socialization
Other:
Required
Supplementary Questions
1. Do you have any dietary restrictions?
*
This is for the event's menu planning.
No
Yes
1.1. If you answered YES on question 1, please provide more details.
Your answer
2. How did you know about us?
*
I am following Cherir FB Page.
I have seen Cherir through FB newsfeeds.
I have seen Cherir through FB ads.
Through referrals from family/friends
Internet Article (through blogs or online magazines)
Internet Search
Other:
Please like our Facebook page for more details and recent updates! :)
www.facebook.com/CherirSpeedDating
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