! - Applicant`s Name Date of Birth

Community
AGENT Apt. #
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1
Date Required
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Applicant's Name
Date of Birth
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Co-Applicant's Name
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Social Security No.
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Amount Paid
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Social Security No.
Date of Birth
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Names, ages and relationship of anyone else who will occupy the apartment:
Current Address
No
( j Rent
( ) Own
( ) Live with family or friend
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Apartment or Landlord's Name:
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Apartment or Landlord's Phone-
t/3
Former Address
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Street
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Name
( ) Own
State
City
No.
( ) Rent
City
State
Street
( ) Live with familv or friend
Zip Code
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City
( ) Other
State
Dates: From
Zip Code
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Apartment or Landlord's Name:
Apartment or Landlord's Phone:
Reason for Moving
Applicant's Emotover
Employer's Address/Location
2
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2
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Position Held
Previous Employer
Date of Hire
Employer's AddressA.ocation
Position Held
Date of Hiro
Co-Applicant's Emotover
Employer's Address/Location
Position Held
Date of Hire
STOP! II DID YOU COMPLETE THE RESIDENCE HISTORY?
YES
IF YOU ANSWERED Mfl, WE CANMOT PROCESS
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Savings Acct
Regular Checkinn
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Has applicant, soouse or any other proposed resident ever
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Vehicles We do not allow vehicles without permission. Vehicles not approved in wriling may be towed away at the owner's expense
Make
Year
Color
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Year
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Filed for bankruptcy
No U Yes _J
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Been evicted from tenancy
No 3 Yes Zl
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Bso11 convicted of a felony
No 3 Yes 3
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YOUR APPLICATION
Bank Name/Location
Color
Comments
IP case of emergency contact
Home Phone
Address.
Citv
State
Zip
s Screening. Inc. .is employees and agents, to lake any and all nctiotw necessary to venfy the contents of this apphcation I understand that sucn acnons
-armto^ fr^n"r^tt,",""^ *
"**" venflcatlon of employment, past rental history, police and criminal records I will hold Complete Screening inc its emplcvees and ace-:
i urSe^ndTh^rnTJ^ST!6 "*""** * *** infomlation to the ^nagemen, arxVor owners. I certify that all information provrfed by me * lrue. correct and com0le,e a-:
understand that any mmpmenmnn or omtsson ,s cause for the management and/or owne* to re,ec. or decline this applet™ and/or termite any lease Dased or lh,s We*
: It is understood and agreed thai the secunty deposit win be FORFEITED if I/we cancel this application after/te hours of s.gning.
Applicant's Signature
Co-Applicant's Signature
Leasing Agent
Date
Date
Date-
In connection with my application for a rental/lease (the "Landlord") may request background records on
me from Complete Screening Inc (CSI). I understand that these reports may include social security trace,
credit bureau reports, criminal background searches, department of motor vehicle records, sex offender
registries and other governmental public record sources. By signing below I give my' consent and
authorization to this landlord and any agency contacted in connection with this application to obtain the
investigative reports as listed above. I release and hold harmless any individual, corporation or private or
public entity from any and all causes of action that might arise from furnishing to the Landlord and/or
Complete Screemng Inc information that they may request pursuant to this release. A photo or faxed copy
of this release will act as the original and shall be valid for this and any future reports or updates that
may be requested by the Landlord in connection with my application.
Signature
.Date
Print Name
Please print legibty. Information that we are unaWe to read could result in a delay in the
application verification process.
Social Security Number _
.Date of Birth
Driver's License Number
_State of Issue
Present Address,
City State Zip
Previous Address
City State Zip
Have you ever been arrested or convicted of a felony/misdemeanor?
If so, where did the arrest/conviction take place?
Please provide details regarding the arrest and/or conviction:
DYes
a No