Credit: Nancy Griswold 
 
------- 
APPLICATION TO LIVE IN WEST VIRGINIA
 
 Name:__________________________
 Nickname:_________________________________
 CB Handle:_____________________
 Address(RFD No.):_________________-__________________________________
 
 Daddy (If unknown, list 3 suspects):
_____________________________________
 
 Mamma:_________________________
 
 Neck Shade: _____Light Red _____Medium Red _____Dark Red
 
 Number of teeth exposed in full grin: Upper_____ Lower_____
 
 Name of Pickup owned:_______________ Height of Truck__________
 Truck equipped with: ____Gun Rack ____4-Wheel Drive ____Confederate Flag
 ____Cassette Deck ____Load of Wood ____Hijacker Shocks ____Radar Detector
 
 ____Mag Wheels ____Dual CB Antennas ____Spittoon ____Camper Top
 ____Air Horns ____Big Dog  ____Mud Flaps ____Toothpick Holder ____Mud-Grip Tires
 ____Raccoon Hide
 
 Number of empty beer cans on floorboard or in bed of pickup truck:_____
 
 BUMPER STICKERS: ____Eat more Possum ____My other car is a piece of shit
 too ____Honk if you love Jesus ____If you ain't a cowboy you aint shit
 ____Redman Chewing Tobacco
 
 Define the following (must be 90% correct):
 1. Grits           6. Sawmill Gravy       11. Cobbler          16. Tater
 2. Goobers         7. Turnip Salad        12. Fatback          17. Pig  Skins
 3. Pinto Beans     8. Shit-on-a-Shingle   13. Tote             18. Okrie
 4. Collards        9. Redeye Gravy        14. Chickin' Fry     19. Shonuf
 5. Sidemeat       10. Soppin' Syrup       15. Poke             20. Chitlins
 
 Favorite Vocalist: ____Reba McEntire ____Conway Twitty ____Loretta Lynn
____ Hank  Williams  Jr. ____Randy Travis ____Ray Wylie Hubbard
____Tammy Wynette  ____Slim Whitman ____Porter Wagone
____ Willie Nelson ____George Jones ____Box Car Willie
 
 Favorite Recreation: ____Square Dancin' ____Possum Huntin' ____Skinny Dippin'
____Craw Daddin' ____Midget Tossin' ____4-Wheelin'____Drankin'
 ____Spittin' Backy ____Bill Chip Throwin'____Honky Tonkin' ____Noodlin'
 ____Other
 
 Name of Son(s): ____Bubba ____Jim Bob ____LeeRoy ____J.D.
 Name of Daughter(s): ____PammySue ____Violet ____Paulette ____Daisy
 
 Weapons Owned: ___Deer Rifle ___Sawed-Off  Shotgun ___Varmint Rifle
___Log Cabin ___Tire Iron ___Power Chain Saw ___Pick Handle ___Hick'ry Switch
 
 Number of Dogs: ___ Type: ___Blue Tick ___Beagle___ Black & Tan ___Bird Dawg
 
 Cap Emblem: ___John Deer ___McCullock Chain Saws ___Budweiser ___Vo-Tech
 ___Skoal ___Coors___ NAPA ___Smile if You're Not Wearing Underwear
 
 Number of Dependents: Legal:________ Claimed:_________
 
 Number of Weeks Unemployed:__________ 
 
 Number of Welfare Checks Received:____________
 
 Memberships: ___KKK ___NRA ___Moose ___PTL Club ___AA ___Bass Club ___VFW
 ___Quiltin' Bee ___American Legion ___United Sons n' Daughters of the Confederacy
 ___John Birch Society
 
 Length of Right leg:________ Length of Left leg:__________
 
 Does your truck contain some part painted the official state color of Primer Red?
 ___Yes ___No
 
 How many cars do you have jacked up on blocks in your front yard?_______
 
 How many kitchen appliances will you keep on your front porch?__________
 
 Will you wear mostly double-knit polyester pants with snags?____________
 
 Do you own any shoes? ____Yes ____No
 If yes, how many?__________
 What year did you last purchase shoes?_________________
 
 Are you married to any of the following: ____Sister ____Cousin ____Sow
 Do you know her name?________________
 
 Does your wife weigh more than your pickup?____________
 
 Can you sign your name and get the spelling right every time?____________
 
 Have you ever stayed sober for a whole weekend?________________
 
 If so, why?________________________________________________________
 
 Can you count: Past 10 with your shoes on?_________________
 
 Do you know any words that have more than four letters?__________________
 
 Have you ever had more than one bath in a week?__________________________
 
 Medical Information: Do you have at least two of the following: ___BO
 ___Head Lice ___Rabies ___Trench Mouth ___Runny Nose ___Bad Breath
 
 IF YOUR APPLICATION IS TURNED DOWN BY THE STATE OF WEST VIRGINIA,
 YOU MAY BE ELIGIBLE IN THE STATES OF ARKANSAS. THEIR STANDARDS ARE 
 SLIGHTLY LOWER.