RENTAL APPLICATION FORM
This application must be accompanied by a check or money order for $25 to cover
the cost of both a credit check and a criminal background check.
Property Address: __________________________________ Move-In Date: ____________
Last Name: ________________________ First: ________________ Middle Initial: ____
Social Security #:_________-_______-__________ Date of Birth: _____/_____/_____
Driver’s License #/State: _________________ /_______
HOUSING HISTORY
Current Address: _______________________________________________________________
How long there? ____________ Reason for leaving: ______________________________
Landlord Name: ______________________________ Phone # ________________________
Previous Address: ______________________________________________________________
How long there? ____________ Reason for leaving: ______________________________
Landlord Name: ______________________________ Phone # ________________________
EMPLOYMENT HISTORY
Current Employer: _______________________________ How long: ________________
Job Title: ________________ Salary: _____________ Phone #: _____________________
Address: _______________________________ Supervisor: _________________________
EMERGENCY CONTACTS
In case of emergency, name/address of two nearest relatives not living with you:
Name: ___________________________________ Relationship: ________________________
Address: _____________________________________ Phone #:______________________
Name: ___________________________________ Relationship: ________________________
Address: _____________________________________ Phone #:______________________
Have you ever been evicted as a tenant? Yes ______ No ______
If so, when/why? ____________________________________________________________
Have you ever been convicted of a criminal offense? Yes ______ No ______
If so, when/what? ___________________________________________________________
How many adults will be occupying the unit? ______________
How many children (under 18) will be occupying the unit? ____________
Please list the names of all occupants:
1. ______________________________________________
2. ______________________________________________
3. ______________________________________________
4. ______________________________________________
5. ______________________________________________
Tenancy will be denied if you misrepresent any information on this application.
If misrepresentations are found after the rental agreement is signed, your
rental agreement will be terminated.
I authorize the agent for the owner of this property to verify the above
information and to obtain a consumer credit report, a criminal background check,
an eviction report and to make any other inquiries as deemed necessary in
determining eligibility for tenancy and assessing credit worthiness. I
understand that the information set out in this Rental Application may be used
for the purposes of responding to emergencies, ensuring the orderly management
of the tenancy, complying with legal requirements, and collection purposes
should rent be left owing or rental property be left damaged at the termination
of lease or end of tenancy.
I further understand that the application fee provided with this application is
non-refundable. This is an equal housing opportunity.
SIGNATURE: _______________________________ DATE: __________________________
Phone #: _______________________ Email Address: ____________________________
