Redneck Application

Redneck Application

             STATE OF ARKANSAS

     Name: ________________  (_) Billy-Bob
               (last)        (_) Billy-Joe
                             (_) Billy-Ray
                             (_) Billy-Sue
                             (_) Billy-Mae
                             (_) Billy-Jack
                             (Check appropriate box)

      Age: ____

      Sex: ____ M _____ F _____ N/A

      Shoe Size ____ Left ____ Right

      (_) Farmer
      (_) Mechanic
      (_) Hair Dresser
      (_) Un-employed

      Spouse's Name: __________________________

      Relationship with spouse:
      (_) Sister
      (_) Brother
      (_) Aunt
      (_) Uncle
      (_) Cousin
      (_) Mother
      (_) Father
      (_) Son
      (_) Daughter
      (_) Pet

      Number of children living in household: ___

      Number that are yours: ___

      Mother's Name: _______________________

      Father's Name: _______________________ 
      (If not sure, leave blank)

      Education: 1 2 3 4 (Circle highest grade completed)

      Do you (_)own or (_)rent your mobile home?  
      (Check appropriate box)

      ___ Total number of vehicles you own
      ___ Number of vehicles that still crank
      ___ Number of vehicles in front yard
      ___ Number of vehicles in back yard
      ___ Number of vehicles on cement blocks
      Model and year of your pickup: _____________ 194_
      Truck equipped with:
      ____gun rack____fuzz buster____8-track
      ____Roll bar____beer cans____squirrel tail
      ____CB radio____rebel flag____centrefold pic

      Newspapers/magazines you subscribe to:
      (_) The National Enquirer
      (_) The Globe
      (_) TV Guide
      (_) Soap Opera Digest
      (_) Rifle and Shotgun

      Number of times you've seen a UFO_____________________
      Number of times you've seen Elvis_____________________
      Number of times you've seen Elvis in a UFO____________
      When was your last Elvis sighting?____________________

      How often do you bathe:
      (_)Not Applicable

      Color of teeth:

      Number of teeth exposed in full grin:

      Brand of chewing tobacco you prefer:

      How far is your home from a paved road?
      (_)1 mile
      (_)2 miles
      (_)don't know

      Neck:___Light red___Medium red___Dark red 

     Bluetick____Beagle____Black & Tan____Other________

     Length of right leg:_____Length of left leg_______

     How many kitchen appliances?:
     ___On front porch    ___On back porch

     Do you wear mostly polyester pants? Yes____No_____

     Do you have any shoes? (no boots)   Yes____No_____

     Do you have any of the following:
     B.O.__  Crabs__  Bad Breath__  Lice__  Scabies  ___Fleas____
     Crossed Eyes___  Runny Nose__  Tattoos___
     Can you count past 10 with your shoes on?     Yes____No____
     Can you count past 21 with your fly up?       Yes____No____

     Favourite weapon: 
     ___tire iron ___pick handle ___chain saw ___shot gun

     Favourite pastime:
     ___drinkin ___coon huntin ___fishin ___other

     Favourite singer:
     ___Willie Nelson ___Johnny Cash ___Conway Twitty ___Elvis
     Bumper stickers:
     ___Honk If You Love Jesus
     ___Dial 1-800-EAT-SHIT
     ___OLD FART

     Cap Emblems:
     ___John Deere ___Skoal ___Budweiser ___Cat
     ___Jack Daniels ___Southern Comfort
     ___NRA ___ VFW ___KKK ___700 CLUB ___B.P.O.E.
     Favourite movie is DELIVERANCE  ___Yes ___No

     Firearms you own and where you keep them:
      ____ truck
      ____ bedroom
      ____ bathroom
      ____ kitchen
      ____ shed

View Stats Free Counters!