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    Candidate
    Background Check Form ™
    As Sent to the Candidates

    The Citizens For A Better America ®

    Candidates who receive a 100% Ranking are sent this form and must complete the Candidate Background Check Form ™, just like the blank one found below, before they can receive our endorsement and be placed on our "Good Guys List" ™. Some candidates do not get past this step in our endorsement process, but those that do are worthy of your support and your vote. (We do not post the completed forms unless there is a violation of the penalty of perjury clause.)

        


    -- THIS IS THE BEGINNING OF THE CITIZENS FOR A BETTER AMERICA (R) BACKGROUND CHECK FORM (TM):

    THE WIDTH OF THIS DOCUMENT IS 72 CHARACTERS. Please adjust your browser to see it correctly.

    This is being e-mailed on: __10_/_09_/2004

    Dear Candidate, _

    Congratulations, you are receiving a one hundred percent (100%) ranking from Citizens For A Better America (R) with the acronym and website of (CFABA.ORG)!

    We were very excited about the answers you gave on your filled in CFABA.ORG Candidate Questionnaire (TM). I am thrilled and delighted to tell you that you have made it past the first of three steps in our endorsement process. You answered perfectly all the questions in our CFABA.ORG Candidate Questionnaire (TM). I can not adequately express to you, what an rare and exciting achievement that you have achieved. Very few candidates do what you have done.

    As we say in our News Release announcing our endorsements, "It is a rare and special candidate(s) that qualify for our endorsements." You have achieved what very few candidates in the history of Citizens For A Better America (R) have achieved. You h ave passed, and made it through our first step in our endorsement process. You answered perfectly our CFABA.ORG Candidate Questionnaire (TM). You do not have our endorsement yet, but you are well on your way.

    This form is for the purpose of evaluating candidates that have passed our initial CFABA.ORG Candidate Questionnaire (TM). That CFABA.ORG Candidate Questionnaire (TM) is used to determine a candidate's core beliefs on political issues that we care about. This evaluation form is used to determine if a candidate's reputation and record is consistent with the standards we set for our candidates.

    We feel these questions must be asked because the voters who are looking for morality and values based candidates expect that we have asked these questions.

    Please answer these questions as honestly and thoroughly as possible. This information is for our evaluation purposes only and will not be distributed to the public unless there is a violation of the penalties of perjury clause. This means you do not need to worry that we will give this information to your opponent now or in the future.

    Please fill out this form by hitting the Reply button on your Internet browser software. Then after you have answered all the questions please reply and e-mail it to us at [MailTo:Candidate@GoodGuysList.org].

    Only, if you have lied do you need to be concerned. We retain the right to defend our reputation even if that means referencing this document if you have falsely answered it. Thank you for your cooperation.

    01. My name will appear on the ballot as?: ________________________________________________.

    02. Within legal, ethical and moral grounds, what are you planning to do to get elected? (If you are answering, "Whatever it takes," then please outline what you mean by that.) ____________________________________________________.

    03. If you lose this election, are you planning to run again and for what office? Please tell us to the best of your ability at this time what your intentions are for running for other office. ____________________________________________________.

    04. What organization(s) have you been a member of (Political Organizations, Boys Scouts, Girls Scouts, Military, Church, Union, etc.): _____________________________________________________.

    LEGAL AND LIFESTYLE CONCERNS:

    05. Have you used illegal drugs?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    06. Have you ever gone through treatment for alcohol or drug abuse?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    07. Do you have any speeding tickets in the last seven years?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    08. What is your view on drinking alcohol? Please write response here:

    ____________________________________________________.

    09. Have you ever had any DUI's or DWI's?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    10. Have you ever been arrested and / or convicted of a crime?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    11. Have the police ever been called out on you?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    12. Have you ever requested the police be called out or have you yourself called the police out for any matter?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    13. Have you ever had a reputation of having a bad or explosive temper?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    14. Have you ever been accused of spousal abuse?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    15. Have you ever been accused or convicted of any form of sexual relations with any minor after you became an adult?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: __________________________________.

    16. If you were convicted of any form of sexual relations with any minor before you became an adult are those records unsealed?
    [ ] Yes
    [ ] n/a
    [ ] Discuss with Robert Colaco
    If yes, please describe: ______________________________.

    17. Have you ever been accused or convicted of any form of child abuse?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please describe: ______________________________.

    18. Have you ever been a victim of any form of child abuse?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, would you like to talk with our Chaplain? ________.

    19. Are you willing to be finger printed for State Criminal Conviction Clearing?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If No, please explain: ________________________________.

    20. Do you have a current driver's license?
    (If yes, DL#: _________________, State: _________________)
    (Expiration Date: ___________

    21. What is your marital status?
    [ ] Never married.
    [ ] Married.
    [ ] Widowed.
    [ ] Divorced once, but not remarried.
    [ ] Divorced once and remarried.
    [ ] Divorced ____ times and not remarried.
    [ ] Divorced ____ times and remarried.
    [ ] Other, please explain____________________________________________.

    22. Are you currently living in a marital way with someone who you are not legally married to?
    [ ] No [ ] Yes

    23. Is there anything about your divorce(s) that could affect your political race?
    [ ] n/a
    [ ] No
    [ ] Yes,
    ___________________________________________________.
    Please explain if your answer was Yes.

    24. Are there any child custody issues, currently?
    [ ] n/a
    [ ] No
    [ ] Yes,
    _____________________________________________________.
    Please explain if your answer was Yes.

    25. Were there any child custody issues in the past?
    [ ] n/a
    [ ] No
    [ ] Yes,
    ___________________________________________________.
    Please explain if your answer was Yes.

    26. Have you ever had an extra marital affair?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If No, please explain: ____________________________________.

    27. Have you ever had a child out of wedlock or as a result of an affair?
    [ ] No
    [ ] Yes,
    ____________________________________________________.
    Please explain if your answer was Yes.

    28. What do you do to make a living? What sources of income do you have?
    ____________________________________________________.

    29. Are you self employed?
    [ ] No
    [ ] Yes,
    ___________________________________________________.
    Please explain if your answer was Yes.

    30. Please tell us about your business, if you are self employed.
    [ ] n/a
    ___________________________________________________.

    31. Have you ever had formal complaints or lawsuits filed against you while you have been in business?
    [ ] No
    [ ] Yes,
    ___________________________________________________.
    Please explain if your answer was Yes.

    32. Do you currently have any pending collection activity in your business from any Federal, State or Local Governmental agency?
    [ ] n/a
    [ ] No
    [ ] Yes,
    __________________________________________________.
    Please explain if your answer was Yes.

    33. Do you or have you frequented what would be considered "Immoral establishments," such as strip bars, prostitution houses, porn theaters, or other such places?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please explain: _______________________________.

    34. Have you ever had a professional type of license revoked, suspended or limited in some way? As an example: A medical license, Attorney's, Certified Public Accountant?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If No, please explain: ____________________________________.

    For questions 35 to 42 please put an [X] in the letter grade you'd give yourself. Letter A is the best and F is the worst.

    35. How is your relationship with your spouse?
    [ ] A [ ] B [ ] C [ ] D [ ] F [ ] n/a
    MORE: ______________________________________________.

    36. Please tell us more about your relationship with your spouse.
    ___________________________________________________.

    37. Please tell us how your spouse feels about you running for office. Please tell us how they would feel if you were to get elected and have to serve your term in your state's capital or in Washington, DC.
    ______________________________________________________.

    38. How is your relationship with your divorced spouse?
    [ ] A [ ] B [ ] C [ ] D [ ] F [ ] n/a
    MORE: ________________________________________________.

    39. How is your relationship with your children?
    [ ] A [ ] B [ ] C [ ] D [ ] F [ ] n/a
    MORE: _______________________________________________.

    40. How is your relationship with your employer?
    [ ] A [ ] B [ ] C [ ] D [ ] F [ ] n/a
    MORE: _______________________________________________.

    41. How are you doing at managing your personal financial matters?
    [ ] A [ ] B [ ] C [ ] D [ ] F [ ] n/a
    MORE: _______________________________________________.

    42. How would you rate yourself at managing to keep your speech i.e. the language you use daily, clean?
    [ ] A [ ] B [ ] C [ ] D [ ] F [ ] n/a
    MORE: _______________________________________________.

    43. Have you or a family member ever been the victim of a violent crime?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please explain: ___________________________________.

    44. Has a minor child of yours been arrested?
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please explain: ___________________________________.

    45. Is there anything out there that your opposition could find against you, that they would be able to use against you? [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If yes, please explain: ___________________________________.

    46. Is there anyone that you can think of who would have a reason to contact Robert Colaco, or Citizens For A Better America (R), and say something like: "You do not know what you are doing by endorsing: ______________________________, (Your Name), because did you know that he has done the negative thing of, ________, (fill in the blank). Some of the examples of those things might be found in the Background Check Fact Sheet (TM) that you have filled out.
    [ ] Yes
    [ ] No
    [ ] Discuss with Robert Colaco
    If No, please explain: ____________________________________.

    This ends our series of questions. As stated in the introduction, Citizens For A Better America (R) "will not endorse any candidate that does not completely fill out and return this BACKGROUND CHECK FORM (TM) as well as a potential phone interview with Robert Colaco, the Volunteer National Chairman and Founder of Citizens For A Better America (R).

    BE SURE TO WRITE: THE DATE, CITY AND STATE YOU SIGNED IT IN, SIGN AND PRINT THE SECTION BELOW.

    WE CONSIDER YOUR PRINTED E-MAIL SIGNATURE TO BE LEGALLY BINDING. THIS CANDIDATE QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE CANDIDATE ONLY. WE RESERVE THE RIGHT TO REQUIRE A FAX COPY OF THIS QUESTIONNAIRE WITH A HANDWRITTEN ORIGINAL SIGNATURE IF WE BELIVE IT IS NECESSARY.

    THE FOLLOWING MUST BE FILLED OUT PROPERLY, OR YOUR COMPLETED CFABA.ORG CANDIDATE QUESTIONNAIRE (TM) WILL BE CONSIDERED INCOMPLETE.

    ======================================================

    EXAMPLE START:

    I HAVE COMPLETED THE ABOVE QUESTIONNAIRE ON
    (date): _10_/_09_/2004 and I am signing this e-mail in
    (city/state):___Van Nuys, California_______________

    _John Jones______________________________________
    (E-Signature) MUST BE SIGNED BY CANDIDATE ONLY

    _John Jones, Candidate for Any Town, USA City Council__
    (Name Printed, Office Sought Printed)

    EXAMPLE END

    ======================================================

    NOW, PLEASE SIGN IT WITH YOUR INFORMATION BELOW:

    I HAVE COMPLETED THE ABOVE QUESTIONNAIRE ON
    (date): ____/____/2004 and I am signing this e-mail in
    (city/state):_____________________________________

    Under penalties of perjury, I declare that I have examined this Background Check Form (TM), including any accompanying statements, and to the best of my knowledge and belief, it is true, correct and complete.

    ____________________________________________________
    (E-Signature) MUST BE SIGNED BY CANDIDATE ONLY

    ____________________________________________________
    (Name Printed, Office Sought Printed)

    This ends the questions part of our official Background Check Form (TM). Thank you for your time.

    Sincerely,

    Robert Colaco, Founder and Volunteer National Chairman

    Congressman Bill Dannemeyer, Honorary National Chairman Member of the U.S. House of Representatives from 1979-1992.

    Leadership of: Citizens For A Better America (R)

    ++++++++++++++++++++++++++

    This CFABA.ORG Background Check Form (TM) was sent to you by: Citizens For A Better America (R), CFABA.ORG Publisher of the "HAVE YOU BEEN LIED TO?" (TM) flyer. Federal, F.E.C. ID #: C00278333 California, F.P.P.C. ID #: 1265022 National Headquarters: PO Box 7647, Van Nuys, California 91409-7647 Voice Mail 24/7: (818)757-1776 Visit our Candidate's Internet Web Site at: http://www.GoodGuysList.org/ e-mail address: [MailTo:Candidate@GoodGuysList.org]

    Visit our Main Internet Web Site at: http://www.CFABA.org/

    (c) Copyright, 1992-2004. All Rights Reserved. Citizens For A Better America (R), CFABA.ORG. This has been authorized, paid for and published by Citizens For A Better America (R). No permission implied or expressed is being given for the use or distribution of this CFABA.ORG Candidate Questionnaire (TM) by any individual or other organization other than Citizens For A Better America (R). This Background Check Form (TM) is the sole property of Citizens For A Better America (R). This CFABA.ORG Background Check Form (TM) and it's distribution has been paid for by Citizens For A Better America (R) and it is authorized and controlled by Citizens For A Better America (R). It is not authorized by any candidate or candidate committee. (TM) = Trademark. (R) Federally Registered Trademark at the United States Patents & Trademarks Office. BC041009.TXT.

    The following names are trademarks (TM) or Registered Trademarks (R) of Citizens For A Better America or Robert Colaco: Advanced Endorsement Program (TM). Basic Endorsement Program (TM). Background Check Form (TM). Citizens For A Better America (R). Commentary and News Release List (TM). Endorsement News Release Candidate Approval Form (TM). Good Guys List (TM). Have You Been Lied To? (TM).

    Absolutely no permission implied or expressed is being given for the use or distribution of any of the above names. You are not authorized to begin or use any of these names as your own. As an example you not authorized to begin a Citizens For A Better America (R), in your city, county, or state or anywhere within all the United States of America (R) and it's territories.

    If you violate any of our trademarks we will send out a News Release to everyone on our Commentary and News Release (TM) that you have done so. We will use the statements within this CFABA.ORG Candidate Questionnaire (TM) to communicate that you have violated our trademark. We also do not rule out bringing severe legal action against those violating copyright and trademark laws. We have needed to communicate these things because unfortunately others have violated our copyright and trademarks.

    Thank you for taking the time to read our CFABA.ORG Background Check Form (TM) and respecting our copyrights, trademarks and federally registered trademarks.

    Sincerely, Robert Colaco, Founder and Volunteer National Chairman

    Congressman Bill Dannemeyer, Honorary National Chairman Member of the U.S. House of Representatives from 1979-1992.

    Leadership of: Citizens For A Better America (R)

    "THIS IS THE END OF THE CITIZENS FOR A BETTER America (R), CFABA.ORG BACKGROUND CHECK FORM (TM)."





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