Note: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, lineage and medical report from your doctor.

Name:________________________ Nickname/Alias:___________________
Date Of Birth:____/____/____ height:______ Weight:______ I.Q.:______
G.P.A.:________ Soc. Sec.#______-___-_______
Driver's License#____________________
Boy Scout Rank:_____________Good Standing: Yes_____No_____
Home Address:_______________________________
City/State/Zip_____________________________
Home Phone#: (___)___________ Car Phone#:_______________ Pager#:__________
Do you own
a. Van?____
b. Truck with oversized tires?____
c. Car with a trunk full of speakers?_____

Do you have any of the following:
a. An earring_____
b. nose ring______
c. belly button ring_____
or piercings on any other body parts_____
Explain:_____________________________________________________
Tattoo?______

(If you answered YES to any of the above questions, discontinue and leave the premises immediately.)

In 30 words or less, what does "LATE" mean to you? ________________________________________________________________

In 30 words or less, what does "DON'T TOUCH MY DAUGHTER" mean to you? ________________________________________________________________

Church you attend_____________________ How often______________________
Best time to interview your pastor?_______________________

Fill In The Blank. Please answer freely, all answers will be confidential.
a. If I were beaten, the last bone I want to be broken broken is: ____________________________________________________
b. The one thing I hope this application does not ask me is ____________________________________________________
c. Now answer the question you filled in on B ____________________________________________________

NOTE: If you have answered any of the previous questions dishonestly (and I will find out), discontinue application. It is advised that you leave the premises quickly keeping your head low and running in serpentine fashion.

I swear that all information provided above is true and correct to the best of my knowledge under penalty of death, dismemberment, electrocution, and/or hot pokers.

_____________________________
Signature (This means sign your name)

Thank you for your interest. Please allow 4 - 6 YEARS for processing. If your application is approved, you will be contacted in writing. Please do not call or write, this could cause you unexpected injury.

If your application is rejected, you will be notified by two men wearing white ties and answering to the names GUIDO and LOUIE