Jerry Springer application
(email 2003-03-05)
Application to go on the Jerry Springer Show
Last name: |
________________ |
First name: |
(_) 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: |
(_) Farmer (_) Mechanic (_) Hair Dresser (_) Unemployed (_) Dirty Politician (_) Preacher (_) Exotic Dancer |
Spouse's Name: | _________________________ |
2nd Spouse's Name: | _________________________ |
3rd Spouse's Name: | _________________________ |
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: | _____ |
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 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: | _________________________ |
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: |
_____ |
Colour of teeth: | (_) Yellow |
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