Rental Application Form

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YOUR!PERSONAL!INFORMATION!
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[NAME& OF& LANDLORD:______________________________]& [‘The& LANDLORD’]& is& committed& to& safeguarding&
the&personal&information&entrusted&to&us&by&the&Applicant.&&Personal&information&means&any&information&about&
an&identifiable&individual.&&This&can&include&but&is&not&limited&to&an&individual’s&name,&home&address&and&phone&
number,& age,& sex,& marital& or& family& status,& financial& information,& educational& history,& or& employment& status.&&
We& manage& your& personal& information& in& accordance& with& Alberta’s& Personal& Information& Protection& Act& and&
other&applicable&laws.&&This&policy&applies&to&the&LANDLORD&and&to&any&person&providing&services&on&our&behalf.&&&
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We&collect&the&personal&information&for&the&purposes&of&assessing&the&Applicant(s)&and&co&coOApplicant[s]&if&any&
as&to&suitability&as&a&tenant&in&general,&and/or&for&a&specific&rental&location.&&&
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Your& completion& of& this& Application& will& be& taken& as& your& consent& to& the& above& use& by& us,& including& both& the&
information&provided&in&the&Application&and&personal&information&obtained&by&us&from&other&sources&as&noted&
in&the&Application.&&We&will&assume&the&same&consent&in&cases&where&you&volunteer&other&personal&information&
for&an&obvious&purpose,&even&though&it&may&not&be&specifically&requested&in&the&Application.&
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You&may&withdraw&consent&to&the&use&and&disclosure&of&personal&information&at&any&time,&unless&the&personal&
information& is& necessary& for& us& to& fulfill& our& legal& obligations.& & We& will& respect& your& decision,& but& may& not& be&
able&to&provide&you&with&rental&accommodation&if&we&do&not&have&sufficient&personal&information.&&&
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I/We,!the!undersigned!(the!‘Applicant’,!and!if!applicable!the!‘CoHApplicant’)!hereby!apply!for!approval!as!a!
Tenant(s)!of!the!Landlord!based!on!the!information!provided!on!this!page!and!the!following!2!pages.!I/We!
understand!that!the!information! provided!will!be!viewed!to!determine!my/our!suitability!for!the!premises!
described!below,!and!any!other!premises!that!the!Landlord!my!deem!appropriate.!
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Address of property

Date occupancy desired:

Maximum no. of occupants: ____ Adults ____ Children (give ages)

1.) Personal Information

Name: Social Insurance Number (optional):

Current Address:

E-mail address:

Phone 1: Phone 2: Date of Birth:

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2.) Co-Applicant’s Personal Information (if applicable)

Name: Social Insurance Number (optional):

Current Address:

E-mail address:

Phone 1: Phone 2: Date of Birth:

 3.) (a.) Previous Tenancy
Landlord’s Name: Landlord’s Phone:

Previous Address:

Time at this location: Monthly Rent:

Reason For Leaving:

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4.) Employment Information

Status:  Full-time Part-Time  Student  Unemployed  Retired

Current Employer:

Address:

Supervisor’s Name: Phone:

Length of Employment: Monthly Wage:

Job Position:

If you have other sources of income that you would like us to consider, please list income, source and person:

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5.) Co-Applicant’s Employment Information

Current Employer:

Address:

Supervisors Name: Phone:

Length of Employment: Monthly Wage:

Job Position:

6.) Credit History description

Have you declared bankruptcy in the past seven (7) years?  Yes No

Have you ever been evicted from a rental residence?  Yes No

Have you had two or more late rental payments in the past 12 months  Yes No
 Have you ever refused to pay rent when due?  Yes No

If you have answered YES to any of the above, please state your reasons and/or circumstances:

7.) Additional Information

Do you wish to bring a pet[s] to the rental premises? If yes, describe the pets:
 Yes No

Do you, or any proposed occupant, smoke? If you are co-applicants, do you consent to a joint
 Yes No credit report?
 Yes No

NOTE: Landlords are not responsible for tenants’ possessions. If accepted you must carry tenant’s
insurance covering your possessions and protecting you against liability.
I/We presently insure our belongings and for third party liability:  Yes No

8.) References (anyone other than a relative)

Name: Relationship: Phone:

Name: Relationship: Phone:

Name Relationship: Phone:

9.) Emergency Contact

Name of a person not residing with you:

Address:

Phone: Relationship:
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The Applicant and/or Co-Applicant acknowledges that pets, barbeques, waterbeds and aquariums
are not permitted without the advance written permission of the Landlord.

If the Landlord permits a pet, an additional Pet Damage Deposit of $______ will be paid to the
Landlord. The Landlord will hold the Deposit(s) until the Tenancy ends.

The Applicant(s) do(es) hereby state that the information contained herein is true and correct, and
contain no misrepresentations. If misrepresentations are found after a residential tenancy agreement
is entered into with the Applicant and/or Co-Applicant, the Landlord shall have the option to
terminate the residential tenancy agreement and seek all available remedies.

The Applicant(s) and/or Co-Applicant authorize the Landlord to obtain tenant history, credit,
personal and employment information from one or more consumer reporting agencies, previous
landlords, employers or previous employers and from other sources of such information, to verify the
information provided by the Applicant[s] and/or Co-Applicant. The Applicant[s] and/or Co-
Applicant authorize(s) the reporting agencies, and any other person, including personnel from any
governmental ministry or agency, to disclose relevant information about the Applicant[s] and/or Co-
 Applicant to the Landlord. If the parties enter into a Residential tenancy agreement, the Applicant[s]
and/or Co-Applicant authorize the above information to be used and disclosed for responding to
emergencies, ensuring the orderly management of the tenancy and complying with legal requirements.
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Signature Date:

Co-Applicant’s Signature: Date:

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