I General Social Data
Your name? Wife’s given and maiden name? Husband’s given name? Full names of children? Names of all other members of the household, and their relation to you? No legitimate children.
II Physical and Mental Conditions
Is the importance of regular sleep, bathing, care of the teeth, and regular action of the bowels appreciated? Physical and mental condition is tenuous, teeth in disrepair.
III Industrial History
What was your work record at these places for speed, accuracy, regularity, sobriety? Employed by the esteemed UrbanDaddy.com, the father of us all. Work is performed with vigor and zeal.
What was the education of each worker in your family? Did you have any vocational training? Trained as a mimeographer until the age of 8.