The New Way to Approve a Man

I didn't make up this application, but I thought it was too funny not to share. (Like I said, there's nothing wrong with knowing who you're dealing with!)

Name (Last, First Middle):
Address (City, State, Zip):
Telephone (home, work & cell):
Date of Birth (including year):
SS#
Weight:
Height:

Do you live with any of the following? (circle all that apply):
Grandmother, Parents, Mother, Father, Girlfriend, Boyfriend, Baby Mama, Shelter, Wife, Auntie, Other

Any Children? (circle yes or 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 or no). If yes, how many times?
Are you or have you ever been on the Down Low? (circle yes or no) (If you answer "Yes" STOP RIGHT HERE!!)
Do you owe child support? (circle yes, no, don't know)

Education:
Do you have a high school diploma or GED? (circle yes or no)
Name of high school if applicable:
*If you did not complete any of the above, please stop here and return to school.
Any college? (circle yes or no)
Still Enrolled? (yes, no, graduated)

Have you ever been to jail? (circle yes or no)
If yes, what for? (be very specific)

Have you ever been to prison? (circle yes or no)
*If you have answered yes to the above question, please stop here and call your P.O. immediately.

Employed? (circle yes or no) *If no, please stop here unless you are in school.
If yes, where and how long?
Do you have health insurance? (circle yes or no)
When did you last visit the dentist?
When was the last time you have been to the doctor? 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, Something that you can't spell

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

*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 or practitioner.
Falsifying information may result in termination of this relationship (if applicable), and immediate induction into the Wack Pack. (ok, obviously I added that part. lol)

Applicant's Signature:
Date:
Print Name :