- Place your Photo here.
Date of birth
Social Security Number
Boy Scout rank
- Do you own or have any of these items:
___ muscle car or sports car
___ earring or piercing anywhere
___ truck with oversized tires
___ exotic pet, such as a snake
___ electric guitar
[If you checked any of these items, discontinue application and leave immediately.]
- Do you:
Do you smoke? Yes No
Do you drink? Yes No
Do you gamble? Yes No
Have you ever been arrested? Yes No
Do you ever drive over the speed limit? Yes No
Have you ever seen Elvis? Yes No
Have you ever seen a UFO? Yes No
Have you ever seen Elvis in a UFO? Yes No
Watched a porn video? Yes No
[If you answered Yes to any of the preceeding questions, discontinue application and leave immediately.]
- Preferred dating activity:
- In 50 words or less, tell exactly what the words “Don’t be late” mean to you.
- You must attach a complete police record and latest diploma or transcript.
Your Signature: _____________________________
Parents’ signatures:____________________________ _________________________________
Police Chief’s signature: ______________________________
___ Walk in the park
___ Watch a School play
___ Minature Golf
[Please allow 4 to 6 years for processing. Any unanswered questions will result in forfeiture of application. Apply at your own risk.