Application Form 705b / 12

Application Form 705b / 12

 

Please enter full name here   ___________________

Date of birth here                   ___________________

 

Part 1

Multiple Choice. Please circle the appropriate answers.

 

1. How would you describe yourself?

A1. A force of nature            or           B1. A cowering simp

A2. An effete intellectual      or           B2. A primordial mammalian brained tempest        of emotion

2. Do you

A. Linger upon the touch of warm skin on a winters day

                                              or

B. Spend time alone perpetually writing entries in an almanac of torment

3. Have you ever

A. Gazed into a pair of eyes that gushed an unfettered wellspring of loveliness all over you

                                             or

B. Stiffened into sullen convulsions of adolescent aversion when a promise turned    away

4. In recent times have you

   A. Left no stone unturned

                                             or

   B. Left the rocks as they stand; in stonewall silence

5. Do you

A. Breathe fire

                                          or

B.  Rasp through lungs that are now charred chambers of loss

 

6. Have you

A. Let go of those moments together

                                         or

B. Allowed yourself to cling to tenuous filaments of hope

 

7. Have you

A. Pursued your vision relentlessly

                                        or

B. Walked away from the crumbling fabric of the dream you thought you'd be living

 

8. Do you tend to

A. Glimpse the vista of your own life through the eyes of a loved one

                                       or

B.  Play the part of a rubber necker at the crash sites of your mistakes

 

9. Have you

A. Known timeless moments with another soul

                                      or

B.  Settled for squandered telephone affection during your nights off

 

10. Within the last ten days have you

A. Unbuckled the armoured robe you wear over your vulnerability

                                      or

B.  Let the fibrous mathematics of past conflicts grow thick over your eyes

 

 

Part 2

 

Please respond to the following questions by circling Y (Yes)  or  N (No)

 

 

1. Would you let someone place their head on your stomach if that was what they wanted?

Y  /  N

 

2a. Have you recently tuned into your favourite radio station only to find it broadcasting dead air?

Y  /  N

 

2b. If Yes (Y) were you unsettled by that?

 

Y  /  N

 

3. When stepping onto a pedestrian crossing with speeding traffic approaching, do you feel a curious lack of fear?

 

Y  /  N

 

4. Do you agree with the following statement:

 

"I would rather breathe the toxic fumes of raised voices than spend another day resting in the icebox of your absence."

 

Y  /  N

 

5. Have you ever really accepted the sheer scale of the barrage?

 

Y  /  N

 

6. When encountering a void that seems incalculably vast, do you tend to look for a small place to curl up and go to sleep?

 

Y  /  N

 

 

 

7a. Have you ever heard the faint slaps of gold coins falling on skin?

 

Y  /  N

 

7b. If No (N) then could you imagine that sound?

 

Y  /  N

 

8. Has the following scenario ever happened to you or anyone that you know?

 

(A man is talking on the telephone) "Hi mum, how're you doin'?...yeah...yeah that’s great!...yeah I'm good...I'm ok....mmm, mm...well I think she's taking it pretty well actually"  (cut to close up on a fish’s face in an aquarium)

 

Y  /  N

 

9. Do you like watching television shows?

 

Y  /  N

 

 

 

 

Thank you for completing this part of the application. Please bring this form with you when you attend the follow up interview.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1999