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RENTAL APPLICATION for apartment/house at: Apt No (if applicable)
Desired lease start date

Applicant
First Name Middle Name Last Name
Age Date of Birth Soc Sec No
Marital Status Email Phone
License Number License State

Other residents (names, ages)

Description of Pets (type, size and ages)

Current Residence, including city and state
Street City State
Current rent     Dates of Residence (start and end)
Landlord
      Name       Address
      Phone       Email
Why you moved or why you chose not to renew the lease.

Currently behind in rent? NoYes If so, how much?
Ever behind in rent? NoYes        If so, how much?

Previous Residence, including city and state
Street City State
Rent     Dates of Residence (start and end)
Landlord
      Name       Address
      Phone       Email
Why you moved or why you chose not to renew the lease.
       03
Ever behind in rent? NoYes    If so, how much?

Applications without answers to all of (i)-(v) in the following question will not be reviewed.
Have you ever
(i) filed for bankruptcy?NoYes        (ii) been evicted?NoYes
(iii) broken a lease? NoYes        (iv) been convicted of a felonyNoYes
(v) been sued for nonpayment of rent or for damages to rental property? No Yes
If you answered Yes to any of (i)-(v), provide an explanation

Vehicles: List all vehicles which may be parked on or near premises
Vehicle 1 Type     Make      License      State
Vehicle 2 Type     Make      License      State
Vehicle 3 Type     Make      License      State

If attending school, what school, what degree or certification are you seeking, and is your expected graduation date?

Employment(s) of Applicant

Employer 1 (Name, address)

9 Position
Salary Per Starting date (year and month) Hours/wk Months/yr
Supervisor 1st & last name Phone Email

Employer 2 (Name, address)

Position
Salary Per Starting date (year and month) Hours/wk Months/yr
Supervisor 1st & last Name Phone Email

If current employment is not local, indicate what your local employment will be
Employer (Name, address)

Position
Salary Per Starting date (year and month) Hours/wk Months/yr
Supervisor Phone local Email

Other income amounts and source(s), including food stamps, social security other public assistance and child support
Food stamps Child Support and Alimony Public Assitance/Social Security
Other

Total Income: Before taxes After taxes

Banking References
Savings Bank Account # Balance
Checking Bank Account # Balance

Installment Obligations
Account holder/description Purpose
Monthly pymt Balance Final Installment Date
Account holder/description Purpose
Monthly pymt Balance Final Installment Date

Personal Reference
First & Last Name How known?
Address/Phone

Nearest Relative
First & Last Name How related?
Address/Phone

How did you find out about this vacancy?

This section of questions for Section 8 applicants only:
How much of your rent do you now pay?
What is the name, phone number and extension of you Section 8 case worker?

How much of your rent will you pay in your new house?
The deposit is equal to one month's rent. When will you have the money for the deposit?

The undersigned promises that all statements above are true and authorize verification of all information given.
If I was asked to pay an application fee,
1) if this application results in a lease, the application fee will be applied to the security deposit.
2) if the rental application is rejected, the application fee will be refunded unless the I (we) have made one or more materially false statements on this application.
Examples of materially false statements include, but are not limited to, not reporting a prior eviction, misrepresentation of employment, and providing an incorrect name as a previous landlord. (A prior eviction does not necessarily disqualify the applicant.)

Signature Date

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