Man Application

THE NEW WAY TO APPROVE A MAN
( Man Application)

Name:(Last, First, Middle)

Address:
City:
State:
Zip:

Telephone:
Home #

Work#

Cell#


Date of Birth:

Age:

SS#:


Weight:

Height:



Ethnicity: (check)
Black
Hispanic
White
Other


Do you live with any of the following: (circle)

Grandmother
Parents
Mother
Father
Girlfriend
Baby Mama
Alone
Shelter
Wife
Auntie
Other


Any Children (circle yes or no)
Yes
No
If yes, how many


How many Baby Mamas?

If more than one, please name below. Use separate sheet of paper if need more room.

1.

2.

3.

Ever been married (circle )
Yes
No
If yes, how many times?


Are you or have you ever been on the Down Low? (circle one)
Yes
No
(If you answer is "Yes" STOP RIGHT HERE!!)

Do you owe child support?
Yes
No
Don't Know


*If your ex-wife is getting state benefits (childcare, food stamps, etc), then you owe somebody something. Especially tax payers. Stop here and go take care of your kids.



Education:

Did you graduate from high school? (circle )
Yes
No
Name of high school (if yes)


Have you received any of the following? (Circle One)
GED
Diploma
Nothing

*If you did not complete any of the above, please Stop here and return to school.

Any college? (circle one)
Yes
No

Still Enrolled:
Yes
No
Graduated

Have you ever been to jail? (circle one)
Yes
No
If yes, what for? (be very specific)



Have you ever been to prison? (circle one)
Yes
No

*If you have answered yes to the above question, please Stop here and call your P.O. immediately.

Employed? (circle)
Yes
No
*If no, please Stop here.

If yes, where and how long?

Do you have health insurance?
Yes
No

When did you last visit the dentist?

When was the last time you have been to the doctor? _
Yes
No
What for?

List any (all) illnesses. Use separate sheet of paper if needed.
Do you have or have you had any of the following? (please circle all that may apply)
Hepatitis
A or B or C
Herpes
Mononucleosis
HIV/AIDS
The Bird Flu
West Nile Virus
Crabs
Chlamydia
Gonorrhea
SARS
Head Lice
Ringworms
Boils
Sex Change
Shingles
Meningitis
Measles
Mumps
Ebola
Bunions
Virus
A Cold
Something that you can't spell

*If you have circled any of these, Stop here and do NOT turn in your application. See the doctor immediately!

Do you or have you ever used (ingested in any way) any of the following: (circle all that apply)
Crack/Cocaine
Heroin
Paint Markers
Ecstasy
Glue
Bad pills
Snuff
Anything under the kitchen sink

*If you have used any of these, then Stop here!

*Please use a separate sheet of paper to compile a list of goals and accomplishments.

By signing below, you agree that all of the information given above is true to the best of your knowledge.

For my protection, you may be asked to provide the following information upon request: state ID, birth certificate, recent payroll stub, a recent clean bill of health from a certified physician and/or practitioner.

Falsifying information will result in termination of this application, and all current and future relationship opportunites with me are out of the question.




Applicants Signature
Date:
Print Name :


Has it come to this ladies? I believe so. If it is at all possible to weed out the druggies, the diseased, the unemployed, the multiple baby daddy or any other undesirable qualities before getting together, then this is a great idea. Far too often we WASTE too much time getting to know someoone only to decide that they are not even worth knowing.

As a matter of fact, this application isnt thorough enough for me. I would add the following questions:

Do you use the words please, excuse me, and thank you often? If no, you better start now.

Do you vote? If no, must be registered in time for next election in order to be considered.
If yes:
Did you vote for Bush? If yes, stop here!!! If you voted for him twice, turn in your voter registration card and seek help immediately.

Do you suffer from erectile dysfunction? If yes, are you taking Viagra? If no, start doing so immediately.

Do you have good credit? If no, stop and go get yourself together.

Do you shower at least once a day?
Do you shower after having a bowel movement?
If no, do you use wet wipes? If no, stop here and re-examine your hygiene habits.

Question #1
Are you generous or financially conservative?
If you answered financially conservative then STOP here and do NOT proceed with the application. This is not negotiable and you need not apply.