Examination of Prospective Date for One of the Rohn Daughters

NOTICE: (1) To be filled out in ink by young man who proposes taking out one of the Rohn daughters on a date, prior to said young man and Rohn daughter leaving the Rohn household.
(2) Examinee shall use honesty and the utmost diligence in completion of exam.
(3) Young man shall also satisfactorily complete gauntlet of verbal questions, administered at the discretion of the head of the Rohn household, or his designee, prior to proceeding with proposed date.
(4) Head of the Rohn household, or his designee, shall be the sole authority on correct answers, examination results, and allowance to proceed on proposed date.
(5) Approval of this exam does not preclude requirement for additional written and/or oral information upon completion of proposed date, or prior to any future date, if deemed necessary by head of Rohn household, or his designee.
(6) Failure of the head of the Rohn household to administer any and all such exams (written and/or oral) on the occasion of any specific date does not preclude his right to do so, for any future date, at any later time.
(7) Annual recertification of this exam may be required.

Section 1: Personal Data (fill in or circle appropriate response)

NAME:

ADDRESS:

PHONE:

HEIGHT: WEIGHT: COLOR EYES: COLOR HAIR:

Do you wear glasses? (Yes/No) Contacts? (Yes/No) Orthodontics? (Yes/No)

Any identifying marks?

Total number of piercings (ear, etc.) ___ (insert number)

[NOTICE: If number is greater than ZERO, stop here. The examination is over.]

Any problems with remembering what time or day it is?

SSN:

DATE OF BIRTH:

PLACE OF BIRTH:

MOTHER'S FULL NAME:

FATHER'S FULL NAME:

MOTHER'S MAIDEN NAME:

How many brothers and sisters?

Do you smoke cigarettes? (Yes/No) Cigars? (Yes/No) Pipes? (Yes/No)

Do you drink alcoholic beverages? (Yes/No)

Do you drink diet Pepsi or diet Coca-Cola? (Yes/No)

Are you on any medication? (yes/No)

Do you take any illegal drugs? (Yes/No)

CHURCH MEMBERSHIP:

PASTOR'S NAME:

[Extra credit for attaching Pastoral letter of recommendation.]

FAVORITE SUBJECT IN SCHOOL:

GPA:

EXTRACURRICULAR ACTIVITIES:

Section 2: Driving Record

Do you have a valid Ohio Driver's License? (Yes/No)

[NOTICE: If "No", examinee shall skip this section, however if motor vehicle is involved in proposed date, examinee must complete Section 3.]

Any restrictions?

What company did you take your driving lessons from?

Date and location of Ohio State Patrol driving exam:

Score on written part of exam:

How many months/years have you been driving?

Ever had your license suspended?

INSURANCE COMPANY:

INSURANCE AGENT NAME:

ADDRESS:

PHONE:

INSURANCE LIABILITY COVERAGE: $_________ (insert amount)

What is the speed limit in a residential area?

If you and the Roadrunner were at a red light, who would be first to the next light?

What is the speed limit in a business district?

What does a yellow traffic signal indicate?

Motorcycles are good for:  (select all that apply)
    (a) Presidential motorcades & parades
    (b) Parma police
    (c) Evil Knievel
    (d) Mode of transportation for date with a Rohn daughter

[NOTICE: If (d) was chosen, stop here and exit premises.]

Section 3: Vehicle Information

WARNING: All answers in this section may be verified for accuracy with the Ohio BMV, State Highway Patrol, or Local Police Department at discretion of head of Rohn household.

Does examinee propose taking Rohn girl on date in a motor vehicle? (Yes/No)

[NOTICE: If "No", examinee can skip this section]

Proposed driver on proposed date: circle one
( Self / Father / Mother / Brother / Sister / Friend )

[NOTICE: If "Father" or "Mother", examinee may skip this section. If proposed driver is anyone else, examinee must complete this section, and a separate quiz of driver will be required.]

OWNER OF VEHICLE:

VEHICLE MAKE:

YEAR:

MODEL:

COLOR:

[Extra credit for Ford/Mercury]

VIN:

LICENSE NO.:

EXP:

ENGINE:

HORSEPOWER:

LAST OIL CHANGE:

NUMBER OF SEAT BELTS:

CURRENT READING OF GAS GAUGE: (E 1/8 1/4 3/8 1/2 5/8 3/4 7/8 F)

Section 4: Police Record

Have you ever been arrested? (Yes/No)

Have you ever been convicted of a misdemeanor? (Yes/No)

Have you ever been convicted of a felony? (Yes/No)

[NOTICE: If yes, stop here, slowly put paper & pen down, then immediately exit premises via nearest door.]

Section 5: General Knowledge

Prior to Mark McGuire, who hit the most home runs in a single season?

What is the speed of light in a vacuum?

When did an Englishman first set foot on North America?

Where is Abraham Lincoln buried?

How far apart are railroad rails spaced?

Section 6: Essay Questions

(Minimum 250 words on each question, you may use the back side of the exam; additional sheets are available if necessary.)

1. What career have you chosen, and why?

2. Describe the type of man you expect to be in 10 years.

3. What lifetime goals do you have in mind for yourself?

Section 7: Certifications

I, ______________________(fill in name), hereby certify that I will honor, cherish and respect ____________ Rohn while on our date, will protect her from harm, and will have her home by the agreed-to curfew below.

I further certify that I have been made aware of the fact that Mr. Rohn owns, maintains in working order, and has practiced the use of, several firearms.

***PRIVACY ACT NOTICE***
Get real! There is no privacy!

[signature]_______________________________

[today's date]_________________

CURFEW: ___________ (PM/AM)

EXAMINEE SHALL NOT WRITE BELOW THIS LINE

FOR HEAD OF ROHN HOUSEHOLD USAGE ONLY:

DETERMINATION: [check one]

___ PROPOSED DATE MAY PROCEED AS PLANNED

___ PROPOSED DATE MAY PROCEED AS PLANNED, BUT LITTLE SISTER WILL GO ALONG

___ PROPOSED DATE MAY PROCEED AS PLANNED, BUT LITTLE SISTER WILL GO ALONG WITH TAPE-RECORDER AND CAMERA

___ PROPOSED DATE MAY PROCEED AS PLANNED, BUT MRS. ROHN WILL GO ALONG