Real Estate Citizens Application

Real Estate Citizens Application

Purpose: This application is submitted by the applicant for consideration to lease, purchase, or otherwise occupy the property identified below. Submission of this form authorizes the owner, manager, or their agents to obtain credit reports, criminal background checks, rental history, employment verification, and other information necessary to evaluate the application. False statements or material omissions may constitute grounds for denial and may be subject to civil or criminal penalties.

Property Identification

Property Address:

Parcel / APN Number:

Applicant Information

Date of Birth:    Social Security Number:

U.S. Citizen    Lawful Permanent Resident    Other:

Length of residency: years    months

Employment and Income

Job Title:    Supervisor:    Phone:

Rental History

Monthly rent / mortgage:    Reason for leaving:

Occupants, Pets & Use

Number of occupants to reside at property:

Pets: Yes    No    If yes, describe:

Background Disclosures

Have you ever been evicted or asked to vacate a dwelling? Yes    No

Have you ever filed bankruptcy? Yes    No

Have you been convicted of a felony or misdemeanor within the past seven years? Yes    No

Presence of known lead-based paint hazards: Yes    No

Known mold or moisture damage: Yes    No

Fees, Deposits & Proposed Terms

Proposed Move-In Date:

Authorization and Certifications

By signing below I certify, under penalty of perjury and in accordance with applicable law, that the information provided in this application is true, complete, and correct. I authorize the owner, manager, their agents, and third-party screening services to obtain reports and to verify any information provided, including credit reports, criminal records, employment and income records, tenant history, and public records. I release any person or entity providing information from liability for providing such information.

I acknowledge that any deposit, fee, or payment made in connection with this application may be subject to the landlord's written policies and applicable law regarding refundable or nonrefundable fees. I further acknowledge that acceptance of this application is at the sole discretion of the owner or manager and may be conditioned upon execution of a separate rental or purchase agreement.

I authorize verification and understand false statements are grounds for denial and may be prosecuted.

Acknowledgment of Privacy and Use of Information

I understand social security number and other personal identifiers will be used solely for identification and screening purposes. The information obtained will be used to determine eligibility for tenancy or purchase and will be retained consistent with applicable privacy laws and the record retention policies of the owner or manager.

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