Kessler Point Apartments
901 Kessler Court, Garden City, Georgia 31408
O-912-964-4452, F-912-964-7929

Applicant Release

In connection with my application for employment and/or residency, I understand that investigative background inquiries are to be made on me including consumer credit, criminal convictions, motor vehicle, and other reports. Further, I understand that your company will be requesting information from various Federal, State, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences as well as claims involving me in the files of insurance companies.

I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. This authorization and consent shall be valid in original, fax, or copy form.

The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose:

Please Print Clearly:

Print Full Name: Sex: Male ___ Female ___

Print other names you have used: Dates used:

Date of Birth (mm/dd/yy): Social Security #:

Address City State Zip

Current Drivers License #: Issuing State:

Other Drivers License #s: Issuing State:

(List last 7 years only)

Have you, or ANYONE (regardless of age) who will be residing with you:

1. EVER been arrested, cited, prosecuted, plead guilty to, or been convicted of a crime? [ ] Yes [ ] No

2. EVER been placed on probation, parole, or effected by the Megan Law? [ ] Yes [ ] No

3. EVER been or currently are a member of a gang? [ ] Yes [ ] No

4. EVER had a or currently have a warrant for your/their arrest? [ ] Yes [ ] No

5. EVER been or currently are involved in ANY criminal activity? [ ] Yes [ ] No

6. EVER been evicted or had a forcible detainer filed against you? [ ] Yes [ ] No

7. EVER moved to avoid eviction or because of problems with other tenants or a landlord? [ ] Yes [ ] No

Explain ALL “YES” answers – IN DETAIL______

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Do you have a legal right to be in the United States?

[ ] Yes, I am a U.S. Citizen

[ ] Yes, I have a valid documentation from the U.S. Department of Immigration and Naturalization (INS) that allows me to be in the Country

[ ] No

I understand that Kole Management has the right to request you to provide documentation that demonstrates U.S. citizenship or a valid visa entry

according to the INS.

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Applicant Signature Date