Housing Forms Series 3b


Complete the information in the form.

Applicant's Name Address City State  /  ZIP
Driver's License # Home or Cell Phone

Work Phone



All Proposed Occupants Age Relationship to Applicant
References/Emergency Contacts Doctor Lawyer Nearest Living Relative
Street Address
State and Zip
Phone Number
  Current Residence Previous Residence Prior Residence
Street Address
State and Zip Code
Amount of rent paid
Dates of Residency
Phone #
Reason for leaving
Did you give notice?
Were you asked to leave?
Names in which your utilities are now billed
Employment History Current Employment Previous Employment Prior Employment
Employed by
Phone #
Name of Supervisor
Monthly Pay
Dates of Employment
Credit History Balance Name of Institution / Bank
Savings Account $
Checking Account $
Credit Card $
Auto Loan $
Vehicle Make / Model Color Year License Plate
Yes No Have you ever been served a late rental notice?
Yes No Do any of the people who would be living in the apartment smoke?
Yes No Have you ever filed for bankruptcy?  If so, when?
How long do you think you would be renting from us?
When would you be able to move in?
Yes No Have you ever been convicted of a felony?
Yes No Have you ever been served an eviction notice?  If so, when?
How many pets do you have? (list type, breed, weight, and approximate age)
Yes No Have you had recurring problems with your current landlord?  If so, please?
  Why are you moving from your current address?