Applicant is applying for a residential dwelling unit located at

Desired move-in date

Applicant information

Full Name

SSN

Date of birth

Phone *

Alternate Phone

Email *

Present address

Address

Street Address

Rental amount

Dates of tenancy

Landlord name

Landlord address

Landlord Phone

Previous address 1

Rental amount

Dates of tenancy

Landlord name

Landlord address

Landlord phone

Previous address 2

Rental amount

Dates of tenancy

Landlord name

Landlord address

Landlord phone

Employment

Current employer

Date of hire

Position

Salary (Wk / Mo / Yr)

Supervisor email & phone

Other occupants (Name / Age / Relationship)

Vehicle information

Number of vehicles

Make

Model

Animals

Name of animal(s)

Type

Breed

Color

Weight

If you are presently in the Armed Services, state:

Branch

Rank

Phone

Other income to consider

Amount (Wk., Mo., Yr.)

Rental & credit history

Reason for leaving current residence

Have you ever refused to pay rent when due, been a defendant in an unlawful detainer action or eviction, or otherwise been sued by a landlord for matters related to a tenancy? If so, please give details and the status of any pending actions:

Yes

Have you ever filed for bankruptcy? If so, please give dates of filing and status of case:

Yes

Have you ever been rejected for tenancy? If yes, please explain.

Yes

Please explain

Three personal references

Reference 1 — Name

Phone #

Reference 2 — Name

Phone #

Reference 3 — Name

Phone #

Criminal history

Has any applicant ever been convicted of, pleaded guilty to, or entered a plea of no contest to any felony, or to any misdemeanor for a crime that involved harm to any other person or property, or moral turpitude? If yes, please give all details, including specific offense, dates, sentences, and any information on the status of any current probation.

Yes

Authorization & signature

Each applicant certifies the information is true and correct. False or misleading information is grounds for immediate disqualification.

Applicant authorizes the Landlord or Landlord's representatives to make any inquiries deemed necessary to verify Applicant is the most qualified based on the stated qualification standards. This verification includes, but is not limited to, direct contact with Applicant's employers, current landlord, previous landlords, friends, personal and professional references, law enforcement agencies, government agencies, consumer reporting agencies, public records, eviction records, and any other sources of information which the Landlord or Landlord's representative may deem necessary. Applicant verifies that the Landlord and Landlord's representatives shall not be held liable for damages of any kind that result from the verification of the information provided. This authorization shall extend through Applicant's tenancy and beyond its expiration for the recovery of any financial obligations, or for any other acceptable purpose. Should the Applicant be denied or face other adverse action based on information received in a consumer report, the Applicant has a right to obtain a free copy of the consumer report, and to dispute the accuracy of the information it contains by contacting the Consumer Reporting Agency.

I have read and agree to the terms and conditions of this Application, and I certify that the information provided is true and correct.

Yes

Signature

Type full name to sign *

Clear

Date of apply *