BIG BROTHER 12 APPLICATION At this point there is no absolute application deadline. However, Producers reserve the right to stop accepting applications without notice so Producers highly encourage applicants to submit applications as soon as possible. Semi-finalist interviews will be determined by Producers at their sole discretion. Please read the Eligibility Requirements/Application Instructions before completing this application. And remember, above all else, you must BE HONEST! Any answer may be verified for accuracy. Don't answer a question hoping to give us the answer we "want" to hear. Region Number of the city located closest to your home: (Refer to the Eligibility Requirements/Application Instructions for this information) Section I: The Basics First Name Middle Name Last Name Maiden Name Name Changes (please explain) Current Address (required): City: State: Zip: Contact Info: Mobile (PH): Home (PH): Work (PH): Email 1: Myspace / Facebook / homepage (list any) Age (as of today): D.O.B: Gender (Circle one) MALE FEMALE Height Weight Marital Status (Circle one) also to be explained in detail later in application) SINGLE MARRIED DIVORCED WIDOWED Do you have any children? How many? Page 1
Current Occupation: (1) Social Security Number Driver s License Number (2) Name, Phone Number, and Address of your Best Friend. _ (3) Name, Phone Number, and Address of the Relative that lives closest to you. _ (4) Name, Phone Number, and Address of an Emergency Contact for you (if different from 9a). _ (5) Relationship/Marital Status (Circle one and answer questions as applicable) SINGLE BOYFRIEND or GIRLFRIEND MARRIED How long? How long? Any previous marriages? If so, how many? NOT MARRIED, BUT LIVE W/SIGNIFICANT OTHER How long? SEPARATED DIVORCED WIDOWED How long? How long have you been divorced? How long were you married? Previous marriages? If so, how many? How long have you been widowed? How long were you married? Previous marriages? If so, how many? (6) If you are married or in a relationship, how would you rate your relationship on a scale of 1-10 (1 being worst, 10 being best)? Please explain. (7) If you are married or in a relationship, how will your partner feel about the potential 3-month separation? _ Page 2
_ (8) What is the highest level of education you ve completed? (Circle one and answer questions as applicable) GRADE SCHOOL HIGH SCHOOL ASSOCIATE COLLEGE DEGREE Dates attended: BACHELOR'S COLLEGE DEGREE Degree(s)/Major(s)? Dates attended: MASTER S COLLEGE DEGREE Degree(s)/Subject(s)? Dates attended: PROFESSIONAL OR DOCTORAL DEGREE Degree(s)/Subject(s)? Dates attended: (9) What school(s)/colleges(s)/university(ies) have you attended/are you attending? (Include the city and state.) If you re currently a student, tell us about your major(s) or course of study. (10) Are you now serving, or have you ever served, in the military (U.S. or otherwise)? If so, please describe which branch of the military, your serial number, highest rank, and when and where served. If you ve left the service, when were you discharged and why? Was it an honorable or dishonorable discharge? (11) Are you a professional performer within the entertainment industry? If so, what do you do? (12) Do you have any acting, singing or performing aspirations? If so, tell us your wishes and goals. Page 3
(13) Have you ever appeared in any television programs or films or movies or commercials or advertisements of any kind? If so, please provide details and describe when you made such appearance(s). (14) Have you ever been arrested, charged with a crime, and/or been subjected to disciplinary charges of any kind (whether through a private or public entity)? If so, please describe the circumstances of the arrest(s), and the charge(s) and/or accusations (include dates and locations). Were you convicted or disciplined, and, if so, in what way? (15) Have you ever had a restraining order issued against you? If so, tell us about it (include dates, city & state). (16) Have you ever had a restraining order issued against someone else? If so, tell us about it (include dates, city & state). (17) Have you ever been involved in any litigation? Are you involved in any pending litigation? If so, tell us about it (include dates). (18) Are there any nude or other revealing or compromising images of you that are available publicly either through the Internet, video or otherwise? If so, please describe and explain. Page 4
Section II: Family & Lifestyle (19) Please list any children s name(s) and age(s): (20) Regardless of your marital status, describe your ideal romantic partner: (21) Describe your relationship with your mother. (22) Describe your relationship with your father. (23) What is/are your favorite food(s)? (24) Do you smoke? If so, what do you smoke and how often? (25) Do you drink alcohol? If so, how often do you drink and how much? (26) If you drink, how often do you get drunk? How do you act when you get drunk? (27) What are your thoughts on religion? (28) Are politics important to you? How often do you vote? Page 5
(29) Have you had any particularly interesting occupation(s) in your past? If so, tell us about it/them _ (30) Do you have any pets? If so, please list their name(s) and type(s). (31) Are you a vegetarian? Do you have any food limitations (e.g. allergies, religious, etc.)? (32) Have you ever lived with roommates? If so, tell us about it. (33) What is your favorite TV show(s)? (34) What is your favorite movie(s)? (35) What kind of music do you like best? Favorite artists? (36) What magazines do you read? (37) What is your favorite color? Why? (38) Do you belong to any affiliations or organizations? (39) Do you have any body art (piercings, tattoos, etc.)? If so, please describe them. Page 6
(40) What are your favorite sports to play? To watch? (41) What are your favorite activities? Section III: Medical & Psychological (42a) Have you been treated for or suffered from any physical or mental illnesses (other than common colds) within the last ten (10) years? (Circle one) YES NO (42b) If you answered "YES" in Question 41a, please provide details, including dates of such mental and/or physical illness(es) (regardless of whether they were diagnosed or undiagnosed and regardless of whether any medical attention was sought), any diagnoses, treatments, any medications taken in connection with such illnesses and the purposes of such medications, and symptoms experienced in connection with such illness(es). (43) Have you ever sought mental health counseling in any form? If so, please provide details. (44) Please list any allergies you have (medications, food, hay fever, dust, etc.) and your current treatment for them (if any). Page 7
(45) Have you ever been diagnosed with, or treated for, alcoholism or any other drug-related addiction? If so, please provide more details, including how long you've been in recovery, if that's the case. (46) Do you have a temper? How often do you lose your temper? What provokes you? (47) How do you deal with anger? (48) How do you deal with someone who intimidates you? (49) When was the last time (if any) you hit, punched, kicked, or threw something in anger? Please provide details. (50) What are you afraid of (e.g., heights, flying, etc.)? Section IV: Your Chance to be Creative (51) List the three adjectives that best describe you. (52) If you could hold any political office, what would it be and why? (53) What is the accomplishment you are most proud of? (54) What are you most ashamed of, either now or in your past? Page 8
(55) Describe your perfect day. (56) Who is your hero and why? (57) List three (3) items you would take with you into the Big Brother house if allowed and why. (58) Have you ever been to a nude beach? If so, what was it like? (59) Finish this sentence: My life's motto is (60) What would you do if Big Brother made you famous? (61) What types of people would you choose to have living with you in the Big Brother house? (62) What types of people would you NOT choose to live with you in the house? (63) What would irritate you about living in a house with about a dozen other people? Page 9
(64) What do you think would be the most difficult part of living in the Big Brother house? Explain. (65) Which past Big Brother houseguest did you like the most? The least? Explain. (66) Do you have a strategy for winning Big Brother? (67) Aside from the cash prize, what do you hope to gain from winning Big Brother? (68) A recurring theme on Big Brother is expect the unexpected. How would you handle the unexpected? Are there any possible twists on the show that would be particularly challenging for you to handle? (69) Is there anything else you'd like to tell us about yourself and why you think you'd make a great Big Brother participant and housemate? Try to differentiate yourself and be creative! (70) Have you ever applied for and/or appeared on any other reality TV shows, dating shows or game shows? If so, please provide details and dates. Dress Shirt Size (S, M, L, XL) T-Shirt Size (S, M, L, XL) Swimsuit Size Page 10
Jacket Size Chest Size Waist Size Pant Size In Seam (men only) Dress Size (women only) Bra Size (women only) Underwear Size Shoe Size Hat Size Left handed Right handed Eye color Read and sign the Release and Waiver below and you re done! RELEASE AND WAIVER Please Print Your Full Name: Please read, fill out, sign, and date the following: I hereby acknowledge that: (i) I have read, and I meet and agree to be bound by, the Big Brother eligibility requirements; (ii) I have answered the previous questions honestly and accurately and will answer any questions put to me by Our House Productions, Inc. ( Producers ) honestly and accurately; (iii) If any information that I provide to the producers of Big Brother is found to be false or incomplete this will be grounds for dismissal from the Big Brother participant selection process, and/or removal from the Big Brother program, if previously selected as a participant; (iv) Even if I meet the eligibility requirements, the Producers have no obligation to interview me, and/or select me as a participant; (v) Even if I am selected as a participant, Producers have no obligation to produce the program and CBS has no obligation to broadcast it, even if conducted; (vi) In the event the show is cancelled, or not broadcast for any reason, Producers and CBS have no obligation to award any prize money; (vii) All decisions by Producer concerning selection of the participants are final and not subject to challenge or appeal; and (viii) Producers have no obligation to return or maintain any materials submitted as part of the application whether or not the applicant is selected as a cast member. Without limiting the foregoing in any way, to the degree that the Materials include any musical or literary compositions in which I (partially or wholly) own, or to which I purport to (partially or wholly) own, the copyright or any publishing rights, I hereby grant to the Releasees, and have the complete, unfettered right to grant to the Releasees, an irrevocable, unlimited, perpetual, worldwide, royalty and payment-free license to use and reproduce such Materials in the Program and in connection with any promotion, publicity, marketing or advertisement for the Program or any exploitation of the Program of any kind, in any and all media now known or which may exist in the future. I understand that the Releasees make no representation that such Materials will or will not be used in any way. By submitting this application I hereby consent to the recording, use and reuse by the Producers of the reality-based television series currently entitled Big Brother (the Program ), CBS Broadcasting Inc., Endemol USA Inc., Endemol Entertainment USA, Inc., Our House Productions, Inc. and any of their respective licensees, assigns, parents, subsidiaries or affiliated entities and each of the respective employees, agents, officers and directors (collectively Releasees ) of my voice, actions, likeness, name, Page 11
appearance and biographical material (i.e. collectively Likeness ) in any and all media now known or hereafter devised, worldwide in perpetuity, in or in connection with the Program. I agree that 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 the application materials (videos, photos, etc.) that I have provided in connection with the Program and any photos and video that Producers will make of me in connection with the program (the Materials ) and all rights therein and thereto including, without limitation, the right to use the Materials and my Likeness in any and all media now known or hereafter devised worldwide, in perpetuity. I further agree that Releasees may use my likeness and the Video 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 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 my Likeness and/or the Materials (including, without limitation, any claim that such use invades any right of privacy and/or publicity). ENTIRE AGREEMENT This release and waiver expresses the entire understanding between me and the Releasees and replaces any and all former and contemporaneous agreements, understandings or representations between me and the Releasees. No modification, alteration or amendment of this agreement will be valid or binding unless in writing and signed by both parties. CHOICE OF LAW This release and waiver shall be deemed to be entered into in Los Angeles County, California, and shall be governed by and interpreted in accordance with the laws of the State of California applicable to agreements executed and fully carried out within California. Subject to the arbitration provisions in the next immediate paragraph below, any action, proceeding or litigation concerning this release or my appearance or participation in the Program may only be brought in Los Angeles County, California, and Producers and I hereby agree that the courts of Los Angeles County, California, shall have exclusive jurisdiction over me and the subject matter of any such proceeding. ARBITRATION OF DISPUTES PRODUCERS AND I AGREE THAT ANY AND ALL DISPUTES OR CONTROVERSIES ARISING UNDER OR RELATING TO THIS AGREEMENT OR ANY OF ITS TERMS, ANY EFFORT BY ANY PARTY TO ENFORCE, INTERPRET, CONSTRUE, RESCIND, TERMINATE OR ANNUL THIS AGREEMENT, OR ANY PROVISION THEREOF, AND ANY AND ALL DISPUTES OR CONTROVERSIES ARISING UNDER OR RELATING TO MY POSSIBLE APPEARANCE OR PARTICIPATION IN THE PROGRAM, SHALL BE RESOLVED BY BINDING ARBITRATION IN ACCORDANCE WITH THE FOLLOWING PROCEDURE: EITHER (I) THE RELEASEES AND I SHALL MUTUALLY SELECT AN ARBITRATOR, WHO SHALL BE A RETIRED JUDGE OF A STATE OR FEDERAL COURT OR (II) IF WE CANNOT AGREE ON SUCH ARBITRATOR, THE RELEASEES AND I SHALL EACH SELECT ONE ARBITRATOR, WHO SHALL BOTH BE RETIRED JUDGES OF STATE OR FEDERAL COURTS AND THOSE TWO ARBITRATORS SHALL THEN SELECT A THIRD ARBITRATOR, WHO SHALL ALSO BE A RETIRED JUDGE OF A STATE OR FEDERAL COURT. ALL ARBITRATION PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE COMMERCIAL ARBITRATION RULES OF THE AMERICAN ARBITRATION ASSOCIATION, THROUGH ITS LOS ANGELES, CALIFORNIA OFFICE. PRODUCERS AND I AGREE THAT THE ARBITRATOR'S RULING, OR ARBITRATORS' RULING, AS Page 12
APPLICABLE, IN THE ARBITRATION SHALL BE FINAL AND BINDING AND NOT SUBJECT TO APPEAL OR CHALLENGE. PRODUCES AND I FURTHER AGREE THAT THE ARBITRATION PROCEEDINGS, TESTIMONY, DISCOVERY AND DOCUMENTS FILED IN THE COURSE OF SUCH PROCEEDINGS, INCLUDING THE FACT THAT THE ARBITRATION IS BEING CONDUCTED, WILL BE TREATED AS CONFIDENTIAL AND WILL NOT BE DISCLOSED TO ANY THIRD PARTY TO SUCH PROCEEDINGS, EXCEPT THE ARBITRATOR(S) AND THEIR STAFF, THE PARTIES' ATTORNEYS AND THEIR STAFF, AND ANY EXPERTS RETAINED BY THE PARTIES; PROVIDED THAT SUCH ARBITRATOR(S) AND THEIR STAFF, THE PARTIES' ATTORNEYS AND THEIR STAFF, AND ANY EXPERTS RETAINED BY THE PARTIES EACH FIRST AGREE IN WRITING THAT SUCH INFORMATION AND DOCUMENTS WILL BE TREATED BY THEM AS CONFIDENTIAL, CONSISTENT WITH THIS PROVISION. NOTWITHSTANDING THE FOREGOING, NOTHING IN THIS PARAGRAPH OR IN ANY OF THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION SHALL PREVENT THE RELEASEES FROM SEEKING PROVISIONAL RELIEF OUTSIDE OF ARBITRATION, INCLUDING BUT NOT LIMITED TO EQUITABLE AND/OR INJUNCTIVE RELIEF, PENDING THE ARBITRATOR S FINAL DECISION MISCELLANEOUS Without limiting the foregoing, any provision of this release and waiver that is invalid, illegal, or unenforceable in any jurisdiction will, as to that jurisdiction, be ineffective only to the extent of such invalidity, illegality or unenforceability, without affecting in any way the remaining provisions hereof in such jurisdiction or rendering that or any other provision of this agreement invalid, illegal or unenforceable in any other jurisdiction. Any laws that require or suggest that the interpretation of a document or agreement, or the resolution of any ambiguities contained therein, should be resolved against the drafter of the document or agreement, are hereby waived. No waiver by any of the Releasees of any term or condition of this agreement will be construed as a waiver by any of the Releasees of any other term or condition; nor will any waiver by any of the Releasees of any default under this release and waiver be construed as a waiver by the Releasees of any other default. It is further understood and agreed that no failure or delay in exercising any right, power or privilege hereunder shall operate as a waiver thereof, nor shall any single or partial exercise thereof preclude any other or further exercise thereof or the exercise of any right, power or privilege hereunder. The Releasees may freely assign, in whole or in part, any of their rights or obligations under this release and waiver. I may not assign my rights and obligations under this agreement. I have signed this release and waiver together with my application on the day of, 200. Signature Print Name Page 13