RENTAL APPLICATION
Every occupant over the age of 18 MUST fill out a separate application
Please fill out this form COMPLETELY and sign where indicated.
PERSONAL INFORMATION
FIRST NAME______MIDDLE______LAST______
DATEOF BIRTH__ /__/__ MARITAL STATUS ______S.S.#______
o SINGLE o MARRIED Since ______o DIVORCED Since ______
DRIVERS LICENSE : STATE______#______
PHONE _ _ o CELL______o HOME ______
WORK ______
EMAIL ______
PRESENT HOME ADDRESS CITY/STATE/ZIP ______
PRESENT LANDLORD______PH#______LENGTH OF TIME__
REASON FOR LEAVING:______
AMOUNT OF RENT______Is your present rent up to date?
o YES o NO
PREVIOUS HOME ADDRESS CITY/STATE/ZIP ______
PREVIOUS LANDLORD______PH#______LENGTH OF TIME__
REASON FOR LEAVING:______
AMOUNT OF RENT______
NEXT PREVIOUS HOME ADDRESS CITY/STATE/ZIP:______
LENGTH OF TIME______
PREVIOUS LANDLORD NAME:______
LANDLORD PHONE ______
REASON FOR LEAVING:______
AMOUNT OF RENT______Was your rent up to date?
o YES o NO
PROPOSED OCCUPANT(S)
NAME______RELATIONSHIP______OCCUPATION ____AGE__
NAME______RELATIONSHIP______OCCUPATION____ AGE__
NAME______RELATIONSHIP______OCCUPATION____ AGE__
NAME______RELATIONSHIP______OCCUPATION____ AGE__
VEHICLE(S) INFORMATION
YEAR____MAKE______MODEL______COLOR______PLATE# STATE______
YEAR___MAKE______MODEL______COLOR______PLATE# STATE______
CURRENT EMPLOYER______
OCCUPATION HOURS/WEEK______/_____
SUPERVISOR NAME______PH#______YEARS EMP______
ADDRESS CITY/STATE/ZIP ______
INCOME:$______o WEEKLY o BIWEEKLY o MONTHLY o YEARLY
LIST ALL OTHERSOURCE OF INCOME
SOURCE:______
$______o WEEKLY o BIWEEKLY o MONTHLY o YEARLY
SOURCE PROOF OF INCOME:
SOURCE:
$______o WEEKLY o BIWEEKLY o MONTHLY o YEARLY
SOURCE PROOF OF INCOME:
INCOME
NO PETS ALLOWED.
CREDITORS OWED:______
EMERGENCY / PERSONAL REFERENCE INFORMATION
EMERGENCY CONTACT______PHONE______
o CELL ______o HOME ______
RELATION______ADDRESS______CITY/STATE/ZIP ______
EMERGENCY / PERSONAL REFERENCE INFORMATION
EMERGENCY CONTACT______PHONE______
o CELL ______o HOME ______
RELATION______ADDRESS______CITY/STATE/ZIP ______
PERSONAL REFERENCE______
PHONE ______o CELL o______HOME______
RELATION______
ADDRESS CITY/STATE/ZIP ______
PERSONAL REFERENCE______
PHONE ______o CELL o______HOME______
RELATION______
ADDRESS CITY/STATE/ZIP ______
APPLICANT QUESTIONNAIRE / AUTHORIZATION
Has applicant ever been sued for bills? o YES o NO Has applicant ever been locked out of their apartment by the sheriff? o YES o NO
Has applicant ever been bankrupt? o YES o NO Has applicant ever been brought to court by another landlord? o YES o NO
Has applicant ever been guilty of a felony? o YES o NO Has applicant ever moved owing rent or damaged an apartment? o YES o NO
Has applicant ever broken a Lease? o YES o NO Is the total move-in amount available now (rent and deposit)? o YES o NO
Applicant authorizes the landlord to contact past and present landlords, employers, creditors, credit bureaus, neighbors and any other sources deemed necessary to investigate applicant.
All information is true, accurate and complete to the best of applicant’s knowledge. Landlord reserves the right to disqualify tenant if information is not as represented.
ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME.
X
______
APPLICANT SIGNATURE DATE
If you have any questions about the interpretation or legality of this form, please consult an attorney or other qualified person.
NOTES:
SCHI Fair Housing and Equal Opportunity Statement
It is the policy of Shiloh Community Housing(SCHI to provide equal employment and fair housing opportunity to all persons and to prohibit discrimination because of race, color, religion, national origin, age, sex, and familial status. SCHI does not discriminate on the basis of disability status in admission or access to its assisted housing programs and activities.
SCHI Page 1 of 3
Status Report Print Date: 12/14/2018
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Version: 0B