Jerry Springer Application Form

Jerry Springer Application Form

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

(_) Dirty Politician

(_) Preacher

(_) Strip Dancer

(_) Hooker

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: ______

Numbers 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 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?

😂 hmm guess it's bad my real name is Billy_Sue 😖

😂 are we suppost to fill ths out? 😑

stupid rednecks

No, you were not ment to fill it in..unless of course you are applying to be on jerry Springer..but if you wish...please, be my guest and fill it in 🙄

ummmm what is that lil?

You know what sandman, you should fill that in and send it to Jerry Springer ✅ you seem exactly like the type! ✅

Are you stupid? 🤨 Can you read? It says, in LARGE letters ''Jerry Springer Application Form'' and you ask me what is it?

Christ!!

settle down lil and if thats a jerry springer form i would hate to see an opra

Originally posted by lil bitchiness
No, you were not ment to fill it in..unless of course you are applying to be on jerry Springer..but if you wish...please, be my guest and fill it in 🙄

😛 i'll fill it in anyway, i'll be Billy Jack

wow..i cant believe i actually filled it out

Last name: _Walker_______________

First name: (Check appropriate box)

(_) Billy-Bob

(_) Billy-Joe

(_) Billy-Ray

(yes) Billy-Sue

(_) Billy-Mae

(_) Billy-Jack

What does everyone call you?

(_) Booger

(_) Bubba

(_) Junior

(_) Sissy

(yes) Other:_ ducky__________________

Age: __17__ (if unsure, guess) _____ Not sure

Shoe Size: __11__ Left __11__ Right

Occupation: (Check appropriate box)

(_) Farmer

(_) Mechanic

(_) Hair Dresser

(_) Unemployed

(_) Dirty Politician

(_) Preacher

(_) Strip Dancer

(yes) Hooker

Spouse's Name:_______Amy__________________

2nd Spouse's Name:________Jithra______________

3rd Spouse's Name:________Kyra______________

Lover's Name:__________TinyTim_________________

Relationship with spouse: (Check appropriate box)

(_) Sister

(_) Brother

(_) Aunt

(_) Uncle

(_) Cousin

(_) Mother

(_) Father

(_) Son

(_) Daughter

(yes) Pet

Number of children living in household: __0___

Number of children living in shed: __too many to count____

Numbers that are yours: ___at least half___

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

Father's Name: ____________a marching band___________(If not sure, leave blank)

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

Total number of vehicles you own: _3__

Number of vehicles that still crank: _0__

Number of vehicles in front yard: _2__

Number of vehicles in back yard: __1_

Number of vehicles on cement blocks: _0__

Firearms you own and where you keep them:

__revolver__ truck

__bazooka__ bedroom

__uzi__ bathroom

__assault rifle__ kitchen

__12 gauge shotgun__ shed

Model and year of your pickup: 1961_

Do you have a gun rack? yes indeedy

If no, please explain:

Newspapers/magazines you subscribe to:

(_) The National Enquirer

(_) The Globe

(yes) TV Guide

(_) Soap Opera Digest

(yes) Rifle and Shotgun

Number of times you've seen a UFO:___4__

Number of times in the last 5 years you've seen Elvis:___7__

Number of times you've seen Elvis in a UFO:__2___

How often do you bathe:

(_) Weekly

(_) Monthly

(yes) Not Applicable

Colour of eyes:

Right__brown___ left___magenta__

Colour of hair:

(_) Blond

(yes) Black

(_) Red

(_) Brown

(_) White

(_) Clairol

Colour of teeth:

(_) Yellow

(_) Brownish-Yellow

(_) Brown

(_) Black

(yes) N/A

Brand of chewing tobacco you prefer:

(yes)Red-Man

How far is your home from a paved road?

(_) 1 mile

(_) 2 miles

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

(_) road?

OMFG Sam..that is hilarious 😂

😂

hey dont laugh...its pretty much all true 😮

LMAO 😂

We should all fill one in..come on people...chop chop!! Fill the answers in bold or different colours 😂

and remember to be honest! we wont hold anybody who's lover is their mother in any less regard no2

hahahahaha

Last name: ___Mullins_____________

First name: (Check appropriate box)

(_) Billy-Bob

(X) Billy-Joe

(_) Billy-Ray

(_) Billy-Sue

(_) Billy-Mae

(_) Billy-Jack

What does everyone call you?

(_) Booger

(_) Bubba

(_) Junior

(_) Sissy

(_) Other__Candy_________________

Age: _19___ (if unsure, guess) _____ Not sure

Shoe Size: _7___ Left 7____ Right

Occupation: (Check appropriate box)

(_) Farmer

(_) Mechanic

(_) Hair Dresser

(_) Unemployed

(_) Dirty Politician

(_) Preacher

(X) Strip Dancer

(_) Hooker

Spouse's Name:_____Preston (Tired Hiker)______

2nd Spouse's Name:____dave123____________

3rd Spouse's Name:_______Tex_____________

Lover's Name:_____Raz______________________

Relationship with spouse: (Check appropriate box)

(_) Sister

(_) Brother

(_) Aunt

(X) Uncle

(X) Cousin

(_) Mother

(_) Father

(_) Son

(_) Daughter

(X) Pet

Number of children living in household: _12____

Number of children living in shed: __5____

Numbers that are yours: __3 or so____

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

Father's Name: __Chris or Craig or Greg__ (if not sure leave blank)

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

Total number of vehicles you own: _5_

Number of vehicles that still crank: _2_

Number of vehicles in front yard: _1_

Number of vehicles in back yard: _1_

Number of vehicles on cement blocks: _2_

Firearms you own and where you keep them:

____truck

____ bedroom

____ bathroom

____ kitchen

_X shed

Model and year of your pickup: 1965

Do you have a gun rack? sure do

If no, please explain:

Newspapers/magazines you subscribe to:

(_) The National Enquirer

(_) The Globe

(_) TV Guide

(X) Soap Opera Digest

(_) Rifle and Shotgun

Number of times you've seen a UFO:__13_

Number of times in the last 5 years you've seen Elvis:___7_

Number of times you've seen Elvis in a UFO:__12_

How often do you bathe:

(_) Weekly

(X)Monthly

(_) Not Applicable

Colour of eyes:

Right_hazel left blue__

Colour of hair:

(_) Blond

(_) Black

(X Red

(_) Brown

(_) White

(_) Clairol

Colour of teeth:

(X) 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!

(X) road?

Last name: ___Joe_____________

First name: (Check appropriate box)

(_) Billy-Bob

(_) Billy-Joe

(_) Billy-Ray

(_) Billy-Sue

(_) Billy-Mae

(yes) Billy-Jack

What does everyone call you?

(_) Booger

(_) Bubba

(_) Junior

(_) Sissy

(_) Other_____hey kid______________

Age: ____ (if unsure, guess) ___16.84972__ Not sure

Shoe Size: __1__ Left __2__ Right

Occupation: (Check appropriate box)

(yes) Farmer

(_) Mechanic

(_) Hair Dresser

(_) Unemployed

(_) Dirty Politician

(_) Preacher

(_) Strip Dancer

(_) Hooker

Spouse's Name:____Billy Mae_____________________

2nd Spouse's Name:_______Billy Sue_______________

3rd Spouse's Name:________Bill Barbara______________

Lover's Name:____________Jennifer L._______________

Relationship with spouse: (Check appropriate box)

(yes) Sister 😘

(_) Brother

(_) Aunt

(_) Uncle

(_) Cousin

(_) Mother

(_) Father

(_) Son

(_) Daughter

(_) Pet

Number of children living in household: ___20.5__

Number of children living in shed: ____29.5__

Numbers that are yours: ___5__

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

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

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

Total number of vehicles you own: _2 1/2__

Number of vehicles that still crank: ___

Number of vehicles in front yard: __2_

Number of vehicles in back yard: __1/2_

Number of vehicles on cement blocks: _5__

Firearms you own and where you keep them:

__3__ truck

___4_ bedroom

__6__ bathroom

___20_ kitchen

____ shed

Model and year of your pickup: 1960 B.C.

Do you have a gun rack? my wives have nice racks 😄

If no, please explain:

Newspapers/magazines you subscribe to:

(yes) The National Enquirer

(_) The Globe

(_) TV Guide

(_) Soap Opera Digest

(yes) Rifle and Shotgun

Number of times you've seen a UFO:__8___

Number of times in the last 5 years you've seen Elvis:__12___

Number of times you've seen Elvis in a UFO:__all the time___ 😐

How often do you bathe:

(_) Weekly

(yes) Monthly

(_) Not Applicable

Colour of eyes:

Right____purple_ left____don't have one_ 😉

Colour of hair:

(_) Blond

(_) Black

(_) Red

(_) Brown

(_) White

(yes) Clairol

Colour of teeth:

(_) Yellow

(_) Brownish-Yellow

(yes) Brown

(_) Black

(_) N/A

Brand of chewing tobacco you prefer:

(sure)Red-Man

How far is your home from a paved road?

(_) 1 mile

(_) 2 miles

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

(huh?) road?

😂 very good lil

i'll fo mine tomorrow if i remember 🙂

😐 jerry