Residential Housing Application

RESIDENTIAL HOUSING APPLICATION

Property Applied For:    Unit #:

Desired Move-In Date:    Lease Term Requested (months):    Monthly Rent Budget: $

PROPERTY IDENTIFICATION

APPLICANT INFORMATION

Date of Birth:    Social Security Number:

Driver's License / ID #:    State Issued:

Length of Residency:    Monthly Payment: $

EMPLOYMENT AND INCOME

Employer Address:

Position:    Supervisor:

Hire Date:    Gross Monthly Income: $

May we contact employer to verify employment? Yes No

RENTAL HISTORY

Yes No    If yes, provide details:

CRIMINAL HISTORY & BACKGROUND

Have you ever been convicted of a felony? Yes No

Have you had criminal charges dismissed or are there pending charges? Yes No

OCCUPANTS, PETS AND VEHICLES

Pets? Yes No    If yes, describe:    Pet Deposit Offered: $

Vehicles (make/model/license/state):

EMERGENCY CONTACT AND REFERENCES

DISCLOSURES

Is the dwelling unit built before 1978? Yes No

Have you had material property damage at prior residences due to water, mold, fire, or other? Yes No    If yes, explain:

AUTHORIZATION AND CERTIFICATION

Applicant authorizes the landlord, property manager and their agents to obtain consumer reports, credit reports, criminal background checks, eviction history, employment and rental history verifications, and other lawful inquiries for the purpose of evaluating this application. Applicant further authorizes any person or entity to release such information. Applicant understands that the information obtained may be retained by the party obtaining it and that false or misleading information may constitute grounds for denial of tenancy or termination of any resulting lease.

Applicant certifies under penalty of perjury that all information contained herein is true and complete. Applicant agrees that landlord may terminate consideration of this application or any lease if any material misstatement or omission is discovered. Applicant acknowledges that application approval is subject to screening criteria and that any deposit required to hold the unit is refundable or nonrefundable as provided separately in writing.

By signing below, Applicant releases all persons and entities from liability for providing information in good faith to the landlord, property manager, or their agents in connection with this application.

NOTICE REGARDING FEES

Any application fee charged is to cover administrative costs of screening and verifying applicant-provided information. Payment of an application fee does not guarantee approval. Fees are nonrefundable when expended for services performed; any balance may be returned in accordance with applicable law.

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