This application will be incomplete and rejected
unless accompanied by a complete financial statement job history, lineage, and current
medical report from your doctor.
_______________________________ DATE OF BIRTH ________________
2. HEIGHT ____________________ WEIGHT __________ I.Q _______
3. SOCIAL SECURITY # _____________ DRIVERS LICENSE #
4. BOY SCOUT
5. HOME ADDRESS _________________ CITY/STATE ___________ ZIP
6. Do you have one MALE and one FEMALE
If No., EXPLAIN
7. Number of years your parents have been married
8. Do you own a van? ______ A truck with oversized tires? ______ A
waterbed? _______ Do you have an earring, nose ring, or belly button ring?
A tattoo_________________ (If "yes" to any of #8, discontinue application and
leave premises )
9. In 50 words or less, what does "LATE" mean to
10. In 50 words or lest, what does "DON'T TOUCH MY
DAUGHTER" mean to you?
11. In 50 words or less, what does 'ABSTINENCE" mean to you?
12. Church you attend _____________ How often do you attend
13. When would be the best time to interview your father, mother and
14. Answer by filling in the blank: please answer freely. ALL
answers are confidential (That means I won't tell anyone-ever-I promise.)
a) If I were shot the last place on my body I would want wounded is
b) If I were beaten, the last bone I would want broken is my
c) A woman's place is in the
d) The one thing I hope this application does not ask me about is
e) When I first meet a girl, the first thing I notice about her is
( NOTE: If your answer begins with "T" or "A",
discontinue. Leave premises keeping your head low and running in a serpentine fashion is
15. What do you want to be IF you grow up?
I SWEAR THAT ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO
THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, NATIVE AMERICAN ANT
TORTURE, ELECTROCUTION, CHINESE WATER TORTURE, RED HOT POKERS, AND HILLARY CLINTON KISS
________________________________________ Signature ( That means your
Thank you for your interest Please allow four to six years for
processing. You will be notified in writing you are approved. Please do not try to call or
write (since you probably can't and it would cause you injury.) if your application is
rejected you will be notified by two gentlemen wearing white ties and carrying violin
cases. (You might want to watch your back)