This is somewhat of my own personal application I've made that fits your questions as well as adds a few if you're interested.
IGN: Jhazy
RANK: P2 (highest is d3 in S4)
AGE: 28
ROLE: ADC main
Champions:
are my 3 main. I also play

STRENGTHS: On time. Don't have much of a life so I can practice and research a lot. Great cohesion with people and players I'm with. Follow instructions/shot caller well. Very vocal about my actions and what we could and knowing my power spikes and when to engage/fight and when not to. I'm decisive and will choose quickly whether to do one thing or another. I don't dwindle on mistakes made in that game and prefer to focus on winning rather than what just happened until after the game. Even after a game we just won I look to see what we could do better as a team to improve. I'm good at listening and focusing on the task at hand
WEAKNESSES: I am skilled in my own role, but not quite so much as others. At least in terms of knowing what they should build/their power spikes etc anyway. When I do make a mistake I will own up to it.
I'm very competitive and here's an example of something I did in another game. I'm wanting to take league to the next level with a team that wants to push as well.
http://www.engadget.com/2010/01/17/the-colossem-jhazy-of-blackrock/
"Jhazy's team STRAIGHT TO THE TOP is a protection warrior + marksman hunter + holy paladin composition. As a team, they are holding down the world's #1 3v3 spot!"
Past team experience: I've been on various teams ranging from gold to diamond quality. Practicing a lot as well as being the shot caller of the teams I've been on, or helping shotcall with another.
Goals: Looking to play professionally eventually and would like to join a team with a similar mindset to progress and practice often. I want to have fun as well. It is a game after all. I want us all to have fun, but I want to win and hopefully the people I play with will make it fun while we win.
VoiP: I have an astro a50 wireless headset with every voice program up to date and no background noise.
TIMEZONE: PST/PDT
Availability: Pretty much any time of the day except for 2 am-8 am. Sleep time