Personal Information

Employment Information
If employed less than 2 years, please give same information on prior occupation
Present Occupation	Bus. Phone
Employer	Supervisor
Self Employed DBA	Title
Business Address	From To
Type of Business	Monthly Gross Income
Prior Occupation	Business Phone
Employer	Supervisor
Self Employed DBA	Title
Business Address	From To
Type of Business	Monthly Gross Income

References
Housing
Current Address
Landlord/Agent
Address
Previous Address
Landlord/Agent
Address
Credit
Bank	Account #
Address	Phone
	Personal Reference
Name
Address
Nearest Relative
Address
Have you ever filed for bankruptcy? Yes No Have you ever been evicted or had a notice of eviction served on you?Yes No Have you ever willfully & intentionally refused to pay any rent when due? Yes No Have you ever been convicted of a misdemeanor or felony other than a parking ticket? Yes No
Are you a current illegal abuser or addict of a controlled substance? Yes No
Have you ever been convicted of the illegal manufacture or distribution of a controlled substance? Yes No
If yes to any of the above, please indicated date of occurrence
Explanation
If yes to any of the above, please indicated date of occurrence
Explanation
If yes to any of the above, please indicated date of occurrence
Explanation


I DECLARE THAT THE FOREGOING IS TRUE AND CORRECT, AUTHORIZE ITS VERIFICATION AND THE OBTAINING OF A CREDIT REPORT. I agree to pay to the property manager a non-refundable screening fee of $40. I further agree that the property manager/landlord may terminate any agreement entered into in reliance on any misrepresentation made above.

Signature ____________________________________________________________ Date __________________