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HOME CURRICULUM VITAE RENTALS ONLINE APPLICATION CONTACT INFO PERSONAL

Online Application Rental Information Rental Address: Street City Date Available Deposit Rent Personal Information Last Name First Name Middle Name Social Security No Birthday MM/DD/YYYY Drivers License State Contact Info: Home Phone Work Phone Cell / Pager Email Present Address: Street City Zip State Rent How Long Landlord Phone Previous Address: Street City Zip State Rent How Long Landlord Phone General Information Other Occupants? No  Yes Number? Ages Relationship Smokers? No  Yes Animals? No  Yes   Number? Type Automobiles Car Make Car Model Year Color License Car Make Car Model Year Color License Employment Information Present Occupation (If employed for less than two years, please fill out Prior Occupation) Employer Supervisor Supervisor Title Job / Title Bus. Phone Date of Employment? Monthly Gross Type of Business Business Address Prior Occupation Employer Supervisor Supervisor Title Job / Title Bus. Phone Date of Employment? Monthly Gross Type of Business Business Address References Personal Reference Name Phone Address Relationship Type Relationship Length Nearest Relative Name Phone Relationship Type More Information Please Answer the Following Have you ever filed a petition of bankruptcy? No  Yes Have you ever been evicted from any tenancy or had an eviction notice served on you? No  Yes Have you ever willfully and intentionally refused to pay rent when due? No  Yes Have you ever been convicted of a misdemeanor or felony other than a traffic or parking violation? No  Yes Are you a current illegal abuser or addict of a controlled substance? No  Yes Have you ever been convicted of the illegal manufacture or distribution of a controlled substance? No  Yes If you answered yes to any of these questions, please indicate when and why: APPLICANT AUTHORIZATION AND CONSENT FOR RELEASE OF INFORMATION By checking "I agree" below, I authorize the preparation of an investigative report for this purpose. I authorize and understand that investigative background inquiries are to be made on myself including consumer credit, eviction, criminal and other reports. Further, I understand that you will be requesting information from various federal, state and other agencies that maintain records concerning past activities relating to my driving, credit, criminal, sex offender, civil, employment, tenancy and other experiences. I release all of the above, including National Credit Reporting and its agents to the full extent permitted by law from any claims, damages, losses, liabilities, and expenses arising from the retrieval and reporting of information. All reports will be kept confidential. According to the federal fair credit reporting act, I am entitled to know if I was denied based on the information obtained and upon written request a disclosure of the source of the public record information and of the nature and scope of the investigative report. I, the undersigned applicant, do hereby certify that the information provided by me is true and complete to the best of my knowledge. Any copy of this document is as valid as the original. Falsifying information could result in denial of tenancy. I agree

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