What I am
Purpose: To screen potential sexual partners.
Directions: Please read though the questions carefully before answering
them. Answer all
questions honestly and to the best of your knowledge.
General Information Section
Last Name: ________Silva___________ First Name ___Joselito__________ Nick Name
_______________
Gender Male _X_ Female __ Age: ______60______ Height Feet 5___ Inches_6__
Weight____140__ lbs.
Breast Cup Size ____ Waist ______ Hips ______
Endowment: Extra Small __ Small _x_ Medium __ Large __ Extra Large __
Enormous __
Phone: (____) ____________ e-Mail: [email protected]_________________________@
________._____
Highest Educational Level: 8th Grade or Less __ High School or less___
High School Grad ___
Some College ___ College Degree _x_ Masters Degree ___ Post Grad ____
Professional __
Occupation: ____retired________________
Married ____ Single _x__ Divorced ___ Separated ___Other____ In A
Relationship_____
Sexual Orientation:
Straight ___ Gay _x___ Lesbian ___ Bi- Sexual ____ Tri- Sexual (Try
Anything) ___
Are you into Sadomaochism(BDSM)? No __ Ye s _x_ Which One? Sadism ___
Masochism ___x_
Place a “X” in the correct answer space and write in the answer if
applicable.
If more than one answer applies, Check All that Apply
Have you been arrested or convicted of any sex crimes? No _x_ Yes ___ (If
yes, stop here turn in
application)
Do you have any history of serious mental illness? (If yes stop here
turn in application). NO
Did you ever have a sex change operation? No _x_ Yes __ (If yes stop here
turn in application)
Have you ever been alien a*****ed and anally probed? No _x_ Yes __ ( If
yes stop here turn in
application)
Do you like having sex with minor k**s? No _x__ Yes __ ( If yes stop here
turn in application
Do you have any sexually transmitted diseases? Yes ( If yes stop here,
return appl. ) ___ No __x_
What age did you start having sex with someone other than yourself? _11___
When was the last time you had sex? Today ___Yesterday __x_ Last Week ___
Last Month ___
More than a month ago ___ More than a year ago ___
Do you use birth control? No _x_ Yes __ What Type ___________
Do you use condoms? Yes __ No _x_
Ever have any STD’s? No _x__ Yes ____ Which Diseases? 1. ______________
2. ____________
How many sexual partners have you had? 0 __ 1 __ 3 to5 ___ 6 to 10 ___
10 to 15 ___ 15 to 20
___ 25 to 35 ___ 36 or more __ More than you can remember __x__
Are you a premature ejaculator? Yes __ No _x_
Have you ever been stuck together? Yes ___ No __x__
Do you sweat when having sex? Yes ___ No _x__
What type of nipples do you have? Pointy _x__ Short ___ Stubby ___
Inverted ___
What type of pubic hair do you have? Shaved __x_ Bush ___ Weave ___
Mohawk ___________
Any Tattoos? Yes _____ Where ________ No ___x__ Want any? Yes _x_ No __
Any Piercings? Yes ___ No _x__ Want any? Yes ___x_ Where _Nipples___________
Any Brandings? Yes ___ No _x__ Want any? Yes _x___ Where __ass __________
Do you like Giving Oral Sex ? No __ Yes _x_ Receiving Oral Sex? Yes – No _x__
Do you Swallow? Yes _x_ No __ Sometimes __Are you a spitter? Yes ___ No
__x_ Sometimes __
Do you do Anal? Yes _x_ No __ Special Occassions __
Do you spank or like to be spanked? Yes _x__ No ___ OPM (Other People’s
Monkey)__
Do you spank your monkey or choke your chicken? Yes __ No _x_
Do you like to shower before sex? Yes __x_ No (It removes the flavors) ___
Do you like to be tied up? Blind folded? _x___ Bitten? _x___ Toys? __x__
Do you like the lights on or off? On _x_ Off ___
Do you like clothes on ____ Partially on ____ Butt Naked __x__
Do you like to involve food in your sessions? Yes ___ No __x_
Do you have any sexual photos or video of yourself? No _x_ Yes __ Want to
make some _x__
Which do you prefer? One on one__ Doubles__ Triples __ More than 3
People __ Group__x_
While having sex, what do you do? Faint__ Cry__ Moan_x_ Wiggle__ Twist__
Jerk about__ Jerk Off
__ Pant__ Sweat___ Scream__ Squirt ___ Hum__ Whistle__ Just lie there__
How do you like your sexual action? Oral _x__ Anal _x__ Intercourse ___
Oral only ___ Intercourse
Only ___ All of the Above ___ All the above minus Anal ___
When you are about to cum do you? : Kick and bite.__ Scratch and
Scream.__ Kiss and Lick.__ Push
back with increasing determination_x_ Fart __
When you are having sex do you? Scream.__ Moan _x_ .Fart __ Bite and
scratch ___
How do you prefer your partner? Small.__ Medium.__ Large _x_ Skinny.__
Wet.__ Thick _x_ Tight
Long __ Stubby __ Pencil Dick ___
Availability, Frequency, Duration, and Tendencies Section
How often do you want to have sex ? Daily__ Weekly__ Monthly__ As much
as possible_x_
How long can you last? 1min ___ 15min__ 30min__ 1hr__ all night_x__
Do you prefer Evenings __x___ Mornings ____ Nooners (Lunch time) _____
When are you available? 8-12am_x_ 1-5pm_x_ 6-10 pm _x_ all night _x_
Midnight – 8 am __
Do you like to have sex: Outdoors _____ Indoors __x__ In the Shower ___
In a Car _____
Do you talk during sex? Yes __ No __ Can’t talk because your mouth is
full _x_ Can Talk
(Ventriloquist) ____
Do you like to talk dirty? Yes __ No_x_ Sometimes__ Always__
Skills and Talent Inventory Assessment Section
Do you like to role play? Yes _x_ No __
Do you like the movie “Deliverance”? Yes __ No ____
Can you squeal like a pig? Yes __ No _x_
What’s your favorite body parts in order? ( 1 being best 5 being last)
Butt _3_ breast _3__ Chest _4__ Mouth _3__ Penis _1__ Vagina _5__ Ears _3__
Eyes _3_
What’s your favorite hole? 1. __Mouth___________ 2. _____ass_______ 3.
______________
Have you ever had sex with an a****l live or other wise? Yes __ No _x_
Do you like to kiss? Yes _x_ No ___ (If no stop here)
Are you tight or loose? Tight _x__ Loose ___ Uptight ___ Other ___________
Did it ever go in the wrong hole? No __x_ Yes ____ Explain
__________________________
Any weird sexual fetishes? ATM ___ Fisting _x__ Golden Showers _x__ Brown
Showers ___ Baby
Diapers __ Other 1_____________ Other 2 _________________ Other 3
_________________
Do you like inter-racial sex? No __ Yes __x_ Preference 1 _BBC__ ___
Preference 2 ___BBC_________
Do you like sex with clowns? No _____ Yes _____ Never tried but would
like to __x__
Do you like sex with midgets? No _____ Yes _____ Never tried but would
like to __x__
Do you like sex with amputees? No _____ Yes _____ Never tried but would
like to __x__
Do you like sex with handicapped? No _____ Yes _____ Never tried but
would like to _x___
Are you handicapped? No_x_ Yes __ Explain
________________________________________
Do you have big hands and feet? No _x_ Yes __ If yes explain
__________________________
Can you hold a “Q-Tip” in your coochie __ booty __ None __
Do you like sexy lingerie? Yes __x_ No ___
What is your preferred pace? Slow__ Fast__ Very fast__ Rigorous___ Rough _x_
Fantasy, Imagination, and Innovation Section
Instructions for this Section, Fill in the Blank.
List your Four Favorite Positions:
1. __All are good______________________________________
2. ________________________________________
3.________________________________________
4._________________________________________
Any special talent or skills None _x_ Yes __ If so, list:
________________________________
What could you do for me that no one else could?:
_______________________________
Most interesting place you've done it:
________At home_________________________________
Where would you like to do it but have not?(Body)
_____Be pierced__________________________
What place would you like to do it but have not?
_________________________________
What would you do to me if we were stuck alone together in an elevator
for an hour by our
selves?:
_____________Blow you______________________________________________________
What tickles your fancy?
______________________________________________________
When you are having sex what do you enjoy the best?
_____________Be beaten___________________
What’s your specialty?
______________________________________________________
What’s your fantasy?
________________________________________________________
Are you a big freak or nymphomaniac? No __ Yes _x_ Explain
__Always wanting sex_______________________
Would you like to try more things with your partner? No __Yes _x_
Do you feel like trying right now?
____Drinking piss__________________________________________
Anything else you want me to know?
__________________________________________
Are you willing to sign a waiver that frees your partner (me) from all
liabilities for any damages or
injuries including but not limited to death, birth, diseases as a result
of our sexual liaisons?
Yes _x_ No__
Sign and Date Here Name ___Joselito____________ Date ___June 25th, 2015________
Directions: Please read though the questions carefully before answering
them. Answer all
questions honestly and to the best of your knowledge.
General Information Section
Last Name: ________Silva___________ First Name ___Joselito__________ Nick Name
_______________
Gender Male _X_ Female __ Age: ______60______ Height Feet 5___ Inches_6__
Weight____140__ lbs.
Breast Cup Size ____ Waist ______ Hips ______
Endowment: Extra Small __ Small _x_ Medium __ Large __ Extra Large __
Enormous __
Phone: (____) ____________ e-Mail: [email protected]_________________________@
________._____
Highest Educational Level: 8th Grade or Less __ High School or less___
High School Grad ___
Some College ___ College Degree _x_ Masters Degree ___ Post Grad ____
Professional __
Occupation: ____retired________________
Married ____ Single _x__ Divorced ___ Separated ___Other____ In A
Relationship_____
Sexual Orientation:
Straight ___ Gay _x___ Lesbian ___ Bi- Sexual ____ Tri- Sexual (Try
Anything) ___
Are you into Sadomaochism(BDSM)? No __ Ye s _x_ Which One? Sadism ___
Masochism ___x_
Place a “X” in the correct answer space and write in the answer if
applicable.
If more than one answer applies, Check All that Apply
Have you been arrested or convicted of any sex crimes? No _x_ Yes ___ (If
yes, stop here turn in
application)
Do you have any history of serious mental illness? (If yes stop here
turn in application). NO
Did you ever have a sex change operation? No _x_ Yes __ (If yes stop here
turn in application)
Have you ever been alien a*****ed and anally probed? No _x_ Yes __ ( If
yes stop here turn in
application)
Do you like having sex with minor k**s? No _x__ Yes __ ( If yes stop here
turn in application
Do you have any sexually transmitted diseases? Yes ( If yes stop here,
return appl. ) ___ No __x_
What age did you start having sex with someone other than yourself? _11___
When was the last time you had sex? Today ___Yesterday __x_ Last Week ___
Last Month ___
More than a month ago ___ More than a year ago ___
Do you use birth control? No _x_ Yes __ What Type ___________
Do you use condoms? Yes __ No _x_
Ever have any STD’s? No _x__ Yes ____ Which Diseases? 1. ______________
2. ____________
How many sexual partners have you had? 0 __ 1 __ 3 to5 ___ 6 to 10 ___
10 to 15 ___ 15 to 20
___ 25 to 35 ___ 36 or more __ More than you can remember __x__
Are you a premature ejaculator? Yes __ No _x_
Have you ever been stuck together? Yes ___ No __x__
Do you sweat when having sex? Yes ___ No _x__
What type of nipples do you have? Pointy _x__ Short ___ Stubby ___
Inverted ___
What type of pubic hair do you have? Shaved __x_ Bush ___ Weave ___
Mohawk ___________
Any Tattoos? Yes _____ Where ________ No ___x__ Want any? Yes _x_ No __
Any Piercings? Yes ___ No _x__ Want any? Yes ___x_ Where _Nipples___________
Any Brandings? Yes ___ No _x__ Want any? Yes _x___ Where __ass __________
Do you like Giving Oral Sex ? No __ Yes _x_ Receiving Oral Sex? Yes – No _x__
Do you Swallow? Yes _x_ No __ Sometimes __Are you a spitter? Yes ___ No
__x_ Sometimes __
Do you do Anal? Yes _x_ No __ Special Occassions __
Do you spank or like to be spanked? Yes _x__ No ___ OPM (Other People’s
Monkey)__
Do you spank your monkey or choke your chicken? Yes __ No _x_
Do you like to shower before sex? Yes __x_ No (It removes the flavors) ___
Do you like to be tied up? Blind folded? _x___ Bitten? _x___ Toys? __x__
Do you like the lights on or off? On _x_ Off ___
Do you like clothes on ____ Partially on ____ Butt Naked __x__
Do you like to involve food in your sessions? Yes ___ No __x_
Do you have any sexual photos or video of yourself? No _x_ Yes __ Want to
make some _x__
Which do you prefer? One on one__ Doubles__ Triples __ More than 3
People __ Group__x_
While having sex, what do you do? Faint__ Cry__ Moan_x_ Wiggle__ Twist__
Jerk about__ Jerk Off
__ Pant__ Sweat___ Scream__ Squirt ___ Hum__ Whistle__ Just lie there__
How do you like your sexual action? Oral _x__ Anal _x__ Intercourse ___
Oral only ___ Intercourse
Only ___ All of the Above ___ All the above minus Anal ___
When you are about to cum do you? : Kick and bite.__ Scratch and
Scream.__ Kiss and Lick.__ Push
back with increasing determination_x_ Fart __
When you are having sex do you? Scream.__ Moan _x_ .Fart __ Bite and
scratch ___
How do you prefer your partner? Small.__ Medium.__ Large _x_ Skinny.__
Wet.__ Thick _x_ Tight
Long __ Stubby __ Pencil Dick ___
Availability, Frequency, Duration, and Tendencies Section
How often do you want to have sex ? Daily__ Weekly__ Monthly__ As much
as possible_x_
How long can you last? 1min ___ 15min__ 30min__ 1hr__ all night_x__
Do you prefer Evenings __x___ Mornings ____ Nooners (Lunch time) _____
When are you available? 8-12am_x_ 1-5pm_x_ 6-10 pm _x_ all night _x_
Midnight – 8 am __
Do you like to have sex: Outdoors _____ Indoors __x__ In the Shower ___
In a Car _____
Do you talk during sex? Yes __ No __ Can’t talk because your mouth is
full _x_ Can Talk
(Ventriloquist) ____
Do you like to talk dirty? Yes __ No_x_ Sometimes__ Always__
Skills and Talent Inventory Assessment Section
Do you like to role play? Yes _x_ No __
Do you like the movie “Deliverance”? Yes __ No ____
Can you squeal like a pig? Yes __ No _x_
What’s your favorite body parts in order? ( 1 being best 5 being last)
Butt _3_ breast _3__ Chest _4__ Mouth _3__ Penis _1__ Vagina _5__ Ears _3__
Eyes _3_
What’s your favorite hole? 1. __Mouth___________ 2. _____ass_______ 3.
______________
Have you ever had sex with an a****l live or other wise? Yes __ No _x_
Do you like to kiss? Yes _x_ No ___ (If no stop here)
Are you tight or loose? Tight _x__ Loose ___ Uptight ___ Other ___________
Did it ever go in the wrong hole? No __x_ Yes ____ Explain
__________________________
Any weird sexual fetishes? ATM ___ Fisting _x__ Golden Showers _x__ Brown
Showers ___ Baby
Diapers __ Other 1_____________ Other 2 _________________ Other 3
_________________
Do you like inter-racial sex? No __ Yes __x_ Preference 1 _BBC__ ___
Preference 2 ___BBC_________
Do you like sex with clowns? No _____ Yes _____ Never tried but would
like to __x__
Do you like sex with midgets? No _____ Yes _____ Never tried but would
like to __x__
Do you like sex with amputees? No _____ Yes _____ Never tried but would
like to __x__
Do you like sex with handicapped? No _____ Yes _____ Never tried but
would like to _x___
Are you handicapped? No_x_ Yes __ Explain
________________________________________
Do you have big hands and feet? No _x_ Yes __ If yes explain
__________________________
Can you hold a “Q-Tip” in your coochie __ booty __ None __
Do you like sexy lingerie? Yes __x_ No ___
What is your preferred pace? Slow__ Fast__ Very fast__ Rigorous___ Rough _x_
Fantasy, Imagination, and Innovation Section
Instructions for this Section, Fill in the Blank.
List your Four Favorite Positions:
1. __All are good______________________________________
2. ________________________________________
3.________________________________________
4._________________________________________
Any special talent or skills None _x_ Yes __ If so, list:
________________________________
What could you do for me that no one else could?:
_______________________________
Most interesting place you've done it:
________At home_________________________________
Where would you like to do it but have not?(Body)
_____Be pierced__________________________
What place would you like to do it but have not?
_________________________________
What would you do to me if we were stuck alone together in an elevator
for an hour by our
selves?:
_____________Blow you______________________________________________________
What tickles your fancy?
______________________________________________________
When you are having sex what do you enjoy the best?
_____________Be beaten___________________
What’s your specialty?
______________________________________________________
What’s your fantasy?
________________________________________________________
Are you a big freak or nymphomaniac? No __ Yes _x_ Explain
__Always wanting sex_______________________
Would you like to try more things with your partner? No __Yes _x_
Do you feel like trying right now?
____Drinking piss__________________________________________
Anything else you want me to know?
__________________________________________
Are you willing to sign a waiver that frees your partner (me) from all
liabilities for any damages or
injuries including but not limited to death, birth, diseases as a result
of our sexual liaisons?
Yes _x_ No__
Sign and Date Here Name ___Joselito____________ Date ___June 25th, 2015________
10 years ago