Note: This application will be incomplete and rejected unless
accompanied by a complete financial statement, lineage history and
current medical report from a doctor of my choosing.
NAME:__________________________________________
NICKNAMES OR OTHER NAMES USED: ______________________________
DATE OF BIRTH:____________
HEIGHT:_________ WEIGHT:___________
IQ:______________ GPA:____________
SOCIAL SECURITY #:__________________ DL#:____________________
BOY SCOUT RANK:_______________
SUNDAY SCHOOL ATTENDED:___________________
Do you have one MALE and one FEMALE parent?________
If "no" explain below.
Number of years parents married:_____
Any brothers or sisters?_______ Are they normal?_______
Do you own or have access to a van ______, a truck with oversized
tires _____, a waterbed _____?
Do you have an ear ring, nose ring, or belly button ring?______
Do you have a tattoo? _______
[If you answer yes to any of these, discontinue application and leave
immediately.]
In 50 words or less, what does "DON'T TOUCH MY DAUGHTER" mean to you?
____________________________________________________________________
In 50 words or less, what does the word "NO" mean to you??
____________________________________________________________________
In 50 words or less, give your definition of "REAL PAIN"
____________________________________________________________________
Were you ever arrested and/or convicted of any offences? If so, list
each offence in chronological order and include the name and rank of
your arresting officer and the place where you served your prison term.
If you run out of space, simply continue on another page.
Date Offence Arresting Officer Name of Prison
_____ _________________ ___________________ ________________
_____ _________________ ___________________ ________________
_____ _________________ ___________________ ________________
_____ _________________ ___________________ ________________
Church you attend: ________________
How often? S, M, T, W, Th, F, S
When would be the best time to interview your mother, father and
minister? _____________________
Please fill in the blanks:
A. If I were shot, the last place on my body I would want wounded
would be my ______________.
B. If I were beaten, the last bone I would want broken would be my ______________.
C. A woman's place is in the __________________.
D. The one thing I hope this application doesn't ask is ___________.
E. When I meet a girl, the one thing I always notice first is her ________________.
(If the answer in "E" involves a body part, leave premises now,
keeping your head low and running in a serpentine fashion.)
F. What do you want to be IF you grow up _________________.
I swear that all the above information is correct to the best of my
knowledge under penalty of death, bodily harm, dismemberment, torture
or mental abuse.
Signature of applicant _________________________________
Signature of father _____________________________________
Signature of mother ____________________________________
Signature of minister ___________________________________
Signature of State Representative _________________________
Thank you for your interest, and it had better be genuine and
non-sexual. Please allow 4-6 weeks for processing, during which your
entire life history will be investigated with a fine tooth comb. You
will be contacted in writing if approved. If denied, please never
apply again. Don't call me, I'll call you.