Jerry Springer show

[MattD]

Thank you for applying to come on the Jerry Springer show.

 

 

 

Please complete the form below and return it so that you may be

 

considered for future shows.

 

 

 

Application to go on the Jerry Springer Show

 

 

 

Last name: ________________

 

First name: (Check appropriate box)

 

(_) Billy-Bob

 

(_) Billy-Joe

 

(_) Billy-Ray

 

(_) Billy-Sue

 

(_) Billy-Mae

 

(_) Billy-Jack

 

 

 

What does everyone call you?

 

(_) Booger

 

(_) Bubba

 

(_) Junior

 

(_) Sissy

 

(_) Other___________________

 

 

 

Age: ____ (if unsure, guess) _____ Not sure

 

 

 

Shoe Size: ____ Left ____ Right

 

 

 

Occupation: (Check appropriate box)

 

(_) Farmer

 

(_) Mechanic

 

(_) Hair Dresser

 

(_) Unemployed

 

(_) Preacher

 

 

 

Spouse's Name:_________________________

 

2nd Spouse's Name:______________________

 

3rd Spouse's Name:______________________

 

Lover's Name:___________________________

 

Gay Lover's Name:___________________________

 

Relationship with spouse: (Check appropriate box)

 

(_) Sister

 

(_) Brother

 

(_) Aunt

 

(_) Uncle

 

(_) Cousin

 

(_) Mother

 

(_) Father

 

(_) Son

 

(_) Daughter

 

(_) Pet

 

 

 

Number of children living in household: _____

 

Number of children living in shed: ______

 

Number that are yours: ______

 

Number you know the name of: ______

 

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

 

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

 

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

 

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: ___

 

Firearms you own and where you keep them:

 

____ truck

 

____ bedroom

 

____ bathroom

 

____ kitchen

 

____ shed

 

Model and year of your pickup: 196_

 

 

 

Do you have a gun rack?

 

If no, please explain:

 

 

 

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 in the last 5 years you've seen Elvis:_____ Number

 

of times you've seen Elvis in a UFO:_____

 

 

 

How often do you bathe:

 

(_) Weekly

 

(_) Monthly

 

(_) Not Applicable

 

 

 

Colour of eyes:

 

Right_____ left_____

 

 

 

Colour of hair:

 

(_) Blond

 

(_) Black

 

(_) Red

 

(_) Brown

 

(_) White

 

(_) Clairol

 

 

 

Colour of teeth:

 

(_) Yellow

 

(_) Brownish-Yellow

 

(_) Brown

 

(_) Black

 

(_) N/A

 

 

 

Brand of chewing tobacco you prefer:

 

(_)Red-Man

 

How far is your home from a paved road?

 

(_) 1 mile

 

(_) 2 miles

 

(_) Just a whoop-and-a-holler!

 

(_) road?

 

 

 

 

 

[Mr Moo]

Bored?

[MattD]

How did you guess?! Monday [censored] blues....