Application for Jerry Springer Show
jerry springer show, redneck tv
Personal Information:
Name___________ Wut uthers calld you ______________
Can U Remember Ure Last Name?
___Yup ___Nope
Can You Spell Your Last Name?
___Yup ___Nope
CB Handle___________
Yore Mama's Name______________
Yore Daddy Name(if known)________________
Spouse's (husband or wife) Name_________________
Other Spouse ______ Dead Spouse ___________
Relationship to spouse:
___Sister ____Brother ____Mother ____Father ___Pet ___Aunt ___Uncle
Occupation:
___Unemployed / Mechanic ___Gun Dealer ___Hair Dresser
___Skinhead ___ Street Walker ____Waitress ___ Exotic Dancer
Number of Children in Household ___ Number of Children in the Shed ___
Do you know how many are yours? ___ Yup ___ Nope ____Don't Care
Circle Highest Level of Education: 1 2 3 4
How Far is Your Mobile Home from the nearest paved road:
___ 1mile __ 5 miles ___ more
Number of Times You Have Survived a Tornado: ___
Number of Vehicles Owned___How many trucks?___
How many in the front yard?___ How many in the Back Yard?___
How many run?___ How many on Cement Blocks?___ Do you have a gun rack in your truck? ___Yup ___Nope If Nope, why not?_______________
Truck Equipment: ___Gun Rack ___Pit Bull ___Spit Cup ___Fuzzy Dice ___Rebel Flag ___Naked Woman Mud flaps ___NRA sticker
Weapons Owned: ___Tire Iron ___Pick Handle ___Beer Bottle __Shotgun
Number of Dogs Owned: ___
Jerry Springer too hot for Television
Number of Homemade Tattoos: ___
Which of the Following Appliances are in your Front Yard?
___Friggerator ___Heatin Stove ___Warsher
___TV ___Freezer
How Many of the Above Appliances Work: ___
Fav-o-rite Recreation:
___Drinkin ___Cow Chip Throwin ___Possum Huntin ___Crawdad Huntin
___Spittin Backy ___Scratchin ___Watchin Wrasslin
If You Can Read, Which Magazines Do You Prefer:
___Soap Opera Digest ___Rifle and Shotgun ___NWA ___TV Guide ___National Enquirer ___True Confessions
Which Stinks Worse:
___Hogpen ___Outhouse ___Spouse
Have You Ever Stayed Sober for More Than
One Day: ___Yup ___Nope
Do You Know Any Words with More Than 4 Letters:
___Yup ___Nope
Can you count higher than the # of fingers you have left on your hands?
___Yup ___Nope
Which is Correct?:
___"I Seed Him" ___"I Did Seen Him" ____ "I don't know his name"
How Many Cartons of Cigarettes Do You Smoke a Day? ___
Math Test: How Many Food Stamps Do the Following Cost?
___Six Pack ___Ciggies ___Shotgun Shells ___Backy ___Prostitute
Number of Times You've Seen:
___A UFO ___ Elvis ___Elvis in a UFO
Health Questionnaire: Which of the Following Do You Have?
___Head Lice ___B.O. ___Crabs ___Runny Nose ___Boils
Can You Remember the Last Time You Bathed?
___Yup ___Nope
What color are your teeth? ___Yellow ___Brown ___Black ___N/A
Circle How many teeth you have 1 2 3 4 5 6 Nun
Fav-o-rite Recreation:
__ Drankin' __ Cow Chip Throwin' __ Possum Huntin' __ Crawdad Huntin'
__ Spittin' Backy __ Scratchin' __ Watchin Wrasslin'
I hereby swear this is the trooth and signd my "X" on ______/________200__
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