ARE YOU OR HAVE YOU EVER BEEN A MEMBER OF SAG/AFTRA? HAVE YOU EVER ACTED OR PERFORMED OUTSIDE OF SCHOOL?
HAVE YOU EVER PREVIOUSLY APPLIED TO APPEAR ON A REALITY TELEVISION SHOW? IF SO, WHAT SHOW OR SHOWS, AND HOW FAR DID YOU GET IN THE PROCESS?
HAVE YOU OR ANY OF YOUR IMMEDIATE FAMILY MEMBERS EVER BEEN DIRECTLY INVOLVED IN ANY CAPACITY IN THE PRODUCTION OF A REALITY TELEVISION SHOW OR DOCUMENTARY? IF SO, WHAT WAS THE PROJECT AND IN WHAT CAPACITY WERE YOU OR THEY INVOLVED?
DO YOU HAVE ANY CHILDREN? WHAT ARE THEIR NAMES AND AGES? ARE THEY LIVING WITH YOU?
DESCRIBE YOUR CULTURAL BACKGROUND:
NAME AND LOCATION (CITY, STATE) OF YOUR HIGH SCHOOL (AND YEARS COMPLETED):
NAME OF COLLEGE(S) AND # OF YEARS COMPLETED (PLEASE INCLUDE DATES OF ATTENDANCE) :
WHAT IS YOUR HIGHEST LEVEL OF EDUCATION?
WHERE DO YOU WORK? WHAT IS YOUR CURRENT OCCUPATION? :
BRIEFLY DESCRIBE YOUR JOB HISTORY:
DO YOU BELONG TO ANY AFFILIATIONS OR ORGANIZATIONS?
WHERE WOULD YOU LIKE TO SEE YOURSELF IN FIVE YEARS?
DESCRIBE YOUR HOMETOWN:
NOT INCLUDING YOUR CURRENT PLACE OF RESIDENCE, IN WHICH OTHER CITIES AND/OR
COUNTRIES HAVE YOU LIVED AND FOR WHAT PERIOD OF TIME?
DESCRIBE YOUR CHILDHOOD:
HOW WOULD YOU CHARACTERIZE YOUR RELATIONSHIP WITH YOUR PARENTS? ARE THEY STILL TOGETHER? HAS YOUR RELATIONSHIP WITH THEM CHANGED MUCH OVER THE YEARS?
DO YOU HAVE SIBLINGS? WHAT IS YOUR RELATIONSHIP WITH THEM LIKE?
WHAT IS THE BIGGEST SECRET YOU'VE EVER KEPT FROM YOUR PARENTS? IS IT STILL A SECRET?
HOW WOULD YOU DESCRIBE YOURSELF IN HIGH SCHOOL?
HOW WOULD YOU DESCRIBE YOURSELF IN COLLEGE?
IN WHAT WAYS HAVE YOU CHANGED SIGNIFICANTLY OVER THE PAST FIVE YEARS?
WHO IN YOUR LIFE DO YOU MOST WANT TO BE PROUD OF YOU?
WHAT ONE THING ABOUT YOU WOULD NO ONE EVER GUESS JUST BY LOOKING AT YOU?
DO YOU LIVE ALONE OR WITH SOMEONE ELSE? DO YOU GET ALONG? WHAT'S THE BEST THING ABOUT YOUR LIVING SITUATION? WHAT'S THE WORST?
HOW IMPORTANT IS IT TO YOU THAT EACH OF THESE THINGS BE DONE?
HOW WOULD SOMEONE WHO REALLY KNOWS YOU DESCRIBE YOUR BEST QUALITIES?
HOW WOULD SOMEONE WHO REALLY KNOWS YOU DESCRIBE YOUR WORST QUALITIES?
IF YOU HAD TO PICK THREE ADJECTIVES TO DESCRIBE YOURSELF, WHAT WOULD THEY BE? EXPLAIN:
IF YOU COULD CHANGE ANY ONE THING ABOUT YOUR PERSONALITY, WHAT WOULD THAT BE?
IF YOU COULD CHANGE ANY ONE THING ABOUT YOUR PHYSICAL APPEARANCE, WHAT WOULD THAT BE?
IN GENERAL, ARE YOU AN EMOTIONAL PERSON?
WHEN WAS THE LAST TIME YOU LOST YOUR TEMPER? WHAT WERE THE CIRCUMSTANCES?
WHEN WAS THE LAST TIME YOU CRIED? WHAT WERE THE CIRCUMSTANCES?
ARE YOU CURRENTLY SEEING ANYONE? WHERE DO YOU SEE THE RELATIONSHIP GOING?
HOW IMPORTANT IS SEX TO YOU? DO YOU HAVE IT ONLY WHEN YOU'RE IN A RELATIONSHIP OR DO YOU SEEK IT OUT AT OTHER TIMES? HOW DID IT COME ABOUT ON THE LAST OCCASION?
DESCRIBE YOUR HIGH SCHOOL DATING LIFE:
DESCRIBE YOUR COLLEGE DATING LIFE:
DESCRIBE YOUR RELATIONSHIP HISTORY SINCE COLLEGE:
DESCRIBE YOUR MOST RECENT RELATIONSHIP. WHY DID IT END?
DO YOU CONSIDER YOURSELF TO BE A ROMANTIC PERSON?
WHATS THE CRAZIEST THING YOU'VE EVER DONE IN THE NAME OF LOVE?
WHAT IS THE MOST ROMANTIC DATE YOU'VE EVER PLANNED OR MOST ROMANTIC THING YOU'VE EVER DONE FOR A DATE?
IS IT IMPORTANT TO YOU TO HAVE YOUR FRIENDS' APPROVAL OF YOUR SIGNIFICANT OTHER? WHY OR WHY NOT?
WHO HAS BEEN THE LOVE OF YOUR LIFE THUS FAR? ARE YOU STILL IN CONTACT?
WHAT IS YOUR MOST POWERFUL ROMANTIC MEMORY?
WHAT IS YOUR MOST POWERFUL SEXUAL MEMORY?
WHAT IS YOUR PROUDEST ROMANTIC ACHIEVEMENT?
WHAT IS YOUR PROUDEST SEXUAL ACHIEVEMENT?
WHAT IS YOUR MOST EMBARRASSING SEXUAL MOMENT?
WHEN YOU MEET A POTENTIAL DATE OR LOVER, ARE YOU THE PURSUER OR THE PURSUED?
DO YOU HAVE ANY PARTICULAR STRATEGY TO WIN OVER A POTENTIAL DATE OR LOVER?
WHAT IS YOUR BIGGEST ROMANTIC REGRET?
WHEN YOU END A RELATIONSHIP, DO YOU TRY TO REMAIN FRIENDS? WHY OR WHY NOT?
WHO FROM YOUR PAST WOULD YOU MOST LIKE TO RECONNECT WITH? WHY?
WHO FROM YOUR PAST WOULD YOU LEAST LIKE TO ENCOUNTER? WHY?
DO YOU BELIEVE IN FATE OR DESTINY?
WHAT ATTRACTS YOU TO SOMEONE PHYSICALLY?
WHAT ATTRACTS YOU TO SOMEONE MENTALLY?
DESCRIBE YOUR IDEAL MATE:
WHAT DO YOU CONSIDER TO BE THE KEY TO A SUCCESSFUL RELATIONSHIP?
WHAT DO YOU THINK HAS PREVENTED YOU FROM MEETING "THE ONE" FOR YOU?
WHAT IS YOUR BEST QUALITY AS A BOYFRIEND/GIRLFRIEND?
WHAT IS YOUR WORST QUALITY AS A BOYFRIEND/GIRLFRIEND?
LOVE IS:
FLIRTING IS:
REJECTION IS:
HAVE YOU EVER DATED OUTSIDE YOUR RACE? IF NO, WOULD YOU? WHY OR WHY NOT?
HAVE YOU EVER BEEN MARRIED? IF SO, WHEN WAS YOUR DIVORCE FINALIZED?
DESCRIBE YOURSELF AS A COMPETITOR:
DO YOU ENJOY DEBATING WITH FRIENDS OR DO YOU PREFER NEUTRAL TOPICS?
PLEASE BRIEFLY STATE YOUR OPINION ON THE FOLLOWING TOPICS:
GUN CONTROL
PEOPLE OF A DIFFERENT SEXUAL ORIENTATION THAN YOU
INTERRACIAL DATING
AFFIRMATIVE ACTION
THE DEATH PENALTY
DO YOU CONSIDER ANY TOPICS TO BE OFF-LIMITS IN CONVERSATION? WHAT ARE THEY? WHEN AND WHERE ARE THEY OFF LIMITS? WHEN ARE THEY NOT?
IF SOMEONE MAKES A STATEMENT YOU STRONGLY DISAGREE WITH OR FIND OFFENSIVE, HOW DO YOU HANDLE THE SITUATION?
WHAT BOTHERS YOU MOST ABOUT OTHER PEOPLE?
DESCRIBE A RECENT MAJOR ARGUMENT YOU HAD WITH SOMEONE. WHO USUALLY WINS ARGUMENTS WITH YOU? WHY?
HAVE YOU EVER HIT ANYONE IN ANGER OR SELF-DEFENSE? IF SO, TELL US ABOUT IT (HOW OLD WERE YOU, WHAT HAPPENED, ETC.)
HOW DO YOU HANDLE CONFLICTS? DO YOU FEEL THAT THIS APPROACH IS EFFECTIVE?
HAVE YOU EVER INTERVENED TO STOP AN ARGUMENT OR FIGHT? IN YOUR OPINION, WHEN DOES AN ARGUMENT ESCALATE TO THE POINT WHERE IT SHOULD BE STOPPED?
WHAT DO YOU DO FOR FUN? DO YOU PREFER INDIVIDUAL OR GROUP ACTIVITIES? DO YOU HAVE ANY HOBBIES?
DO YOU HAVE ANY BODY ART (PIERCINGS, TATTOOS, ETC.)?
DESCRIBE THE BEST DAY OF YOUR LIFE THUS FAR:
DESCRIBE THE WORST DAY OF YOUR LIFE THUS FAR:
WHAT ACTION(S) OR ACCOMPLISHMENT(S) IN YOUR LIFE ARE YOU PROUDEST OF?
WHAT IS YOUR GREATEST REGRET?
DO YOU LIKE TO TRAVEL? DESCRIBE ONE OR TWO OF THE BEST OR WORST TRIPS YOU HAVE
TAKEN. WHERE WOULD YOU MOST LIKE TO TRAVEL?
DESCRIBE A MAJOR EVENT OR ISSUE THAT'S AFFECTED YOU PERSONALLY:
WHAT IS THE MOST IMPORTANT ISSUE OR PROBLEM FACING YOU TODAY?
WHAT IS THE BIGGEST OBSTACLE YOU'VE HAD TO OVERCOME IN YOUR LIFE?
DO YOU HAVE ANY HABITS WE SHOULD KNOW ABOUT?
DO YOU: SMOKE CIGARETTES? CIRCLE (YES/NO) DRINK ALCOHOL? (YES/NO) IF YES, WHAT IS YOUR FAVORITE ALCOHOLIC BEVERAGE? HAS YOUR DRINKING EVER CAUSED SOCIAL, LEGAL OR FINANCIAL PROBLEMS IN YOUR LIFE?
ARE YOU ON ANY PRESCRIPTION MEDICATION? IF SO, WHAT, AND FOR HOW LONG HAVE YOU BEEN TAKING IT?
PLEASE LIST ANY ALLERGIES YOU HAVE (MEDICATIONS, FOOD, HAY FEVER, DUST,
ETC.) AND YOUR CURRENT TREATMENT FOR THEM:
ARE YOU NOW SEEING, OR HAVE YOU EVER SEEN A THERAPIST OR PSYCHOLOGIST? WHAT WERE THE CIRCUMSTANCES THAT LED YOU TO SEEK TREATMENT?
HAVE YOU BEEN TREATED FOR ANY SERIOUS PHYSICAL OR MENTAL ILLNESS(ES) WITHIN
THE LAST THREE YEARS- PLEASE CIRCLE: YES / NO
IF YES, PLEASE DESCRIBE IN DETAIL, CITING DATES, DIAGNOSIS AND ANY ON-GOING MEDICAL
PROBLEMS:
HOW WOULD YOU DESCRIBE YOUR CURRENT HEALTH?
HAVE YOU EVER BEEN ARRESTED OR HAD A RESTRAINING ORDER TAKEN OUT AGAINST YOU? WHAT WERE THE CIRCUMSTANCES OR CHARGES AND WHAT WAS THE EVENTUAL OUTCOME?
HAVE YOU EVER PLACED A RESTRAINING ORDER AGAINST SOMEONE ELSE? WHAT WERE THE CIRCUMSTANCES AND WHAT WAS THE EVENTUAL OUTCOME?
IS THERE ANY PART OF YOUR LIFE YOU WOULD PREFER NOT TO SHARE?
DO YOU HAVE ANY FRIENDS OR FAMILY MEMBERS WHO WOULD OBJECT TO BEING ON OR WOULD PREFER NOT TO BE ON TELEVISION?
ARE YOU A LEGAL RESIDENT OF THE UNITED STATES? YES NO
ARE YOU AVAILABLE TO LEAVE YOUR FAMILY, WORK, AND FRIENDS TO TRAVEL TO A DISTANT LOCATION (IF NECESSARY) FOR APPROXIMATELY THREE WEEKS YES NO
HAVE YOU EVER BEEN A PARTY TO A CIVIL LAWSUIT? YES NO
IF YES, PLEASE DESCRIBE, TELL US WHEN THE EVENT OCCURRED, AND WHAT THE OUTCOME WAS:
PLEASE LIST BELOW, TO THE BEST OF YOUR KNOWLEDGE, ANYONE YOU KNOW OR HAVE KNOWN WHO IS NOW, OR HAS BEEN IN THE PAST TWO YEARS, AN OFFICER, EMPLOYEE, AGENT OR REPRESENTATIVE OF:
(A) NBC STUDIOS, INC., NATIONAL BROADCASTING COMPANY, INC. ("NBC") OR ITS PARENT (GENERAL ELECTRIC COMPANY, INC.) OR AFFILIATED OR SUBSIDIARY COMPANIES (INCLUDING, WITHOUT LIMITATION, NBC WEST, LLC, OR NBC ENTERPRISES, INC.);br>
(B) ANY PERSON OR ENTITY INVOLVED IN THE DEVELOPMENT, PRODUCTION, DISTRIBUTION OR OTHER EXPLOITATION OF THE SERIES OR ANY VARIATION THEREOF;br>
(C) ANY SPONSOR OF THE SERIES OR ITS ADVERTISING AGENCY; ORbr>
(D) ANY PERSON OR ENTITY SUPPLYING PRIZES OR OTHER SERVICES TO THE SERIESbr>
LIST ALL TV GAME OR CONTEST SHOWS ON WHICH YOU HAVE APPEARED, WHETHER OR NOT YOU WON A PRIZE. (YOU MAY NOT APPEAR IN THE SERIES IF YOU HAVE APPEARED AS A CONTESTANT ON MORE THAN ONE GAME OR CONTEST SHOW WITHIN THIS PAST YEAR OR IF YOU HAVE APPEARED AS A CONTESTANT ON MORE THAN TWO GAME OR CONTEST SHOWS WITHIN THE PAST 5 YEARS.)
HAVE YOU APPLIED OR AUDITIONED TO BE ON ANY TV SHOWS IN THE PAST YEAR? YES NO
IF YES, WHICH ONES?
ARE YOU CURRENTLY BEING CONSIDERED FOR ANY OTHER REALITY SHOWS, INCLUDING, WITHOUT LIMITATION, ANY GAME OR CONTEST SHOWS? YES NO
IF YES, WHICH ONES?
WILL YOU BE APPEARING ON ANY TV SHOWS THAT ARE SCHEDULED TO AIR IN THE NEXT YEAR? YES NO
IF YES, WHICH ONE(S?
DO YOU KNOW ANYONE ELSE WHO IS APPLYING TO BE ON THE PROGRAM? YES NO
IF YES, PLEASE LIST THEIR NAME(S) AND ADDRESS (ES):
LIST 4 PEOPLE WHO HAVE KNOWN YOU FOR A LONG TIME AND WILL TELL US MORE ABOUT YOU (EXCLUDING RELATIVES):
NAME  ADDRESS PHONE HOW DO THEY KNOW YOU?
1.
2.
3.
4.
Please help us get in touch with you. If you have other people (roommates, significant other, boss, relatives, etc.) who frequently know where you are and how to get in touch with you, please list them below. As we cast on a short schedule, getting in touch with you quickly helps everyone.
NAME: RELATION: PHONE:
NBC CASTING: SECOND CHANCE STORIES
ELIGIBILITY REQUIREMENTS
1) You must be a legal U.S. Resident.
2) You must be at least 21 years old as of May 1, 2003.
3) You must not be a candidate for public office and must agree not to become one until after one (1) year after the initial broadcast of the programs in which you appear, if selected as a participant.
4) You must not be married now, or at any time during the taping of the Program.
5) Neither you nor any member of your immediate family or anyone living in your household may be currently employed by or have been employed within the last two (2) years by, or be a close acquaintance of anyone employed by or employed within the last two (2) years by, or be or have been within the last two (2) years an officer, director or agent of any of the following:
(a) NBC Studios, Inc. ("Producer") , National Broadcasting Company, Inc. ("NBC") or its parent (General Electric Company, Inc.) or affiliated or subsidiary companies (including, without limitation, NBC West, LLC, or NBC Enterprises, Inc.);
(b) Any person or entity involved in the development, production, distribution or other exploitation of the television program for which you are applying (the "Program") or any variation thereof;
(c) Any sponsor of the Program or its advertising agency; or
(d) Any person or entity supplying prizes or other services to the Program.
In addition, Producer reserves the right to render ineligible any person who Producer determines, in its sole discretion, is sufficiently connected with the production, administration, judging, or distribution of the Program such that his or her participation in the Program could create the appearance of impropriety.
6) If selected as a potential participant, you must execute waivers and release agreements as required by the Producer or NBC, or any of their licensees, successors or assigns.
7) You will need to be available for a period of up to three consecutive weeks to the production and be willing to travel to a remote location within the greater Los Angeles area, as well as other remote locations within the United States designated by Producer in its sole discretion.
8) If requested by the program producers, you must be willing to submit medical information to the production and submit to a medical examination, psychological examination, and/or background check.
AGREEMENT AND RELEASE
By signing below, I hereby acknowledge that: (i) I have read and I meet and agree to be bound by the eligibility requirements; (ii) I have completed this application honestly and accurately; (iii) if any of the information in this application is found to be false or incomplete, this will be grounds for dismissal from the participant selection process, and/or from the contest and/or from the televisio program tentatively entitled "Second Chance Stories" (the "Program") if selected; (iv) even if I meet the eligibility requirements, NBC Studios, Inc. ("Producer") has no obligation to interview me, and/or select me as a participant; (v) I agree to keep strictly confidential all information about the Program that I acquire during the participant selection process and/or my participation in the Program; (vi) my voice, actions, and likeness will be recorded as a part of this application and participant selection process, and I understand that Producer may, but is in no way obligated to, actually use such recordings within or in connection with the Program, including, without limitation, in advertisements, promotions, publicity, marketing, merchandising, or in any other manner; (vii) even if I am selected as a participant, Producer has no obligation to produce the Program and NBC has no obligation to broadcast it, even if produced; (viii) all decisions by Producer concerning selection of participants are final and not subject to challenge or appeal; and (ix) Producer has no obligation to return any materials submitted by me as part of the participant selection process whether or not I am selected as a participant, and Producer may, but is in no way obligated to, use any such materials in and in connection with the Program, including, without limitation, in advertisements, promotions, publicity, marketing, merchandising, or in any other manner.
By submitting this application, I hereby consent to the recording, use and reuse by Producer and NBC, and any of Producer's or NBC's respective licensees, assignees, parents, subsidiaries, or affiliated entities and each of their respective employees, agents, officers and directors (collectively "Releasees") of my voice, actions, likeness, name, appearance, biographical material, and any information contained in or derived from my application to be a participant in the Program, including, without limitation, any recordings or still pictures of me taken during the participant selection process, or contained in any materials submitted by me in connection with my application (collectively "Likeness") as edited, altered, or modified by Producer, in any and all media now known or hereafter devised, worldwide in perpetuity, in or in connection with the Program, including, without limitation, in advertisements, promotions, publicity, marketing, merchandising, or in any other manner. I agree that the Releasees may use all or any part of my Likeness, and may alter or modify it regardless of whether or not I am recognizable. I further agree that Releasees exclusively own all right, title, and interest (including, without limitation, all copyrights) in and to any recording made by any of the Releasees as well as any video that I have provided in connection with my application and any other materials that I have provided or may provide in connection with the Program (the "Materials") including, without limitation, the right to edit, alter or modify the Materials and to use all or part of the Materials and my Likeness in any manner and in any and all media now known or hereafter devised worldwide, in perpetuity. Without in any way limiting the foregoing, I agree that Releasees may use my Likeness and the Materials in connection with any promotion, publicity, marketing or advertisement for the Program. I grant the rights hereunder whether or not I am selected to participate in the Program in any manner whatsoever. I release Releasees from any and all liability arising out of their recording or use of my Likeness and/or the Materials. I agree not to make any claim against Releasees as a result of the recording or use of my Likeness and/or the Materials (including, without limitation, any claim that such use defames me or invades any right of privacy and/or publicity).
I grant Producer the right to record, reproduce and publicly perform any music I perform during my audition in connection with the production, exploitation, and promotion of the Program. I waive all claims to and agree that I shall receive no royalties of any kind now or in the future from Producer for the use of such music on the Program, including without limitation, copyright, public performance, mechanical or synchronization royalties
By signing this application, to the maximum extent permitted by law, I hereby release Producer, NBC, any television station or channel, cable network, or satellite network that airs the Program, the other participants in the Program, the advertisers connected with the Program, each of their respective parent, subsidiary and affiliated companies, all other persons and entities connected with the Program, and each of their respective officers, directors, agents, representatives, employees, successors, assignees, and licensees (herein the "Released Parties") from any and all claims, actions, damages, liabilities, losses, costs and expenses of any kind (including, without limitation, attorneys' fees) arising out of, resulting from, or by reason of, my application for or participation on or in connection with the Program, including, without limitation, my participation in the participant selection process of the Program, any exploitation of the Program or my appearance on the Program, the failure of Producer to select me as a participant, the cancellation of the Program, any use of my Likeness or the Material, or the exercise by Producer of any rights granted by me hereunder on any legal theory whatsoever (including, but not limited to, personal injury, rights of privacy and publicity, false light, or defamation) (the "Released Claims"). The Released Claims specifically include, without limitation, any and all claims, actions, damages, liabilities, losses, costs and expenses of any kind resulting from the actions of another participant or any other third party at any time.
I understand that neither I nor anyone else will be paid for my granting the above rights, or for my signing this agreement. My participation in the casting process for the Program, and in the Program itself, does not constitute a performance and will not entitle me to wages, salary, or other compensation.
I authorize Producer to investigate, access and collect information about me, about any of the statements made by me in my application, any supporting documents and any other document that I have signed or do sign in connection with my application to be selected as a participant in the Program, or any other written or oral statements I make in connection therewith. I acknowledge and agree that any such information obtained by Producer pursuant to this paragraph or otherwise may be used for purposes of selecting participants in the Program, and may be described or otherwise related in and in connection with the Program, including, without limitation, in advertisements, promotions, publicity, marketing, and merchandising, and in any other manner.
I have read, understand, and agree with the foregoing.
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND COMPLETE. I UNDERSTAND THAT ANY FALSE STATEMENT BY ME MAY LEAD TO MY DISQUALIFICATION OR THE FORFEITURE OF ANY PRIZE I MAY WIN ON THE PROGRAM.
SIGNATURE__________________________________ DATE_____________
*****Please remember to staple a photocopy of your driver's license or passport to this packet. Thank you for your time and effort in completing this form.
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