PERSONAL INFORMATION
Date : Cell Phone #:
Name of Applicant :Telephone
:
Address : E-mail
Address:
How long have you lived at present address :
Are you a student :
Name and Address of Current Landlord:
Telephone :
Residences over past five years:
Address
Landlord Landlord Phone
No. Dates
Date of birth :
Number of tenants? :
Adults : Children :
Pets :
Kind of pet:
Description:
Employer :
Position :
How Long? :
Rate of Pay :
Hours worked/week :
Employer's Telephone :
Supervisor's Name :
SPOUSE OR ROOMMATE INFORMATION
Name : Date of
Birth :
ADDITIONAL PERSONAL REFERENCES
Name:
Relationship :
Telephone :
Name:
Relationship :
Telephone :
ADDITIONAL INFORMATION
HAVE YOU EVER Filed for bankruptcy? :
If yes, when?
Been served an eviction notice or been asked to vacate a property you
were renting? :
Willfully or intentionally refused to pay rent when due? :If yes, when? :
Rental Unit Applied for? :
Criminal History :
Lease Start Date :
Term :Rent/Month :$How were you referred to us? :
Is everything true on this application under penalty of perjury?
I/We declare the foregoing information is true and correct, and I/We hereby authorize you to conduct an employment, rental reference and credit check and to verify our rental history.
___________________ ______
___________________ _______
Applicant's Signature Date
Co-Applicant's Signature Date