NOTE: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, linage and current medical report from your doctor. Please be prepared to submit additional information (like psychological profile and polygraph test) as required.
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1. Name:________________________________ Date of Birth:______________________
2.Height:______________ Weight:____________ I.Q._____________ GPA:____________
3.Social Security
Number:__________________________
Driver's
License#:________________________________
4.Boy Scout Rank:_______________________________
5.Home Address:__________________________________ City:____________________
6.State:_______________________________________
Zip
Code:_____________________________________
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7.How far can
you run: 40 yards?___________________
2
miles?______________________________________
8.Do you own
a?
A)Van___________________________
B)Truck with
oversized tires?__________
C)Waterbed?______________________
Do you have an earring, nose ring or belly button ring?_____________ Tatoo?______________
NOTE: If you answered YES to any part of questions #8, discontinue the application process and leave the premises!
9.In 50 words
or less, what does "LATE" mean to
you?_______________________________________________________________________
___________________________________________________________________________
10.In 50 words
or less, 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 minister?_____________________________________
14.Answer by
filling in the blanks. Please answer freely. All answers are confidential.
(That means
I won't tell anyone, ever)
If I were shot,
the last place on my body I would want to be wounded is
the___________________________________________.
If I were
beaten, the last bone I would want broken
is__________________________________.
A Women's
place is in the _________________________.
The one thing
I hope this application does not ask me about
is____________________________________________.
In the unfortunate
event of my untimely death, I would like___________________________to be
contacted.
My greatest
fear is__________________________________________.
When I first
meet a girl, the first thing I notice about her is
her______________________________________________________.
NOTE: If the answer to the last question begins with a "B", discontinue the application process and leave the premises. Keep your head low and running in a serpentine fashion is advised.
15.What do you want to be "IF" you grow up? __________________________________________________________________________
16.Have you
ever been fingerprinted?______________________________
Had a DNA
sample taken and recorded?___________________________
17.Your dentist
is_____________________________________________
Emergency
phone #____________________________________________
I SWEAR THAT
ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT, UNDER PENALTY
OF DEATH,
DISMEMBERMENT, NATIVE AMERICAN ANT
TORTURE,
ELECTROCUTION,
CHINESE WATER TORTURE AND/OR HOT POKERS.
Signature___________________________________
Thank you
for your interest. Please allow 4-6 years for processing. You will be contacted
in writing if you are approved.Please do not try to call or write.
(It could
cause disqualification and injury to your body).
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