Works Projects Administration

Rental Application Each individual 18 or older must complete a separate application Applicant Information:

First Name: ______Last Name: ______SSN: ______Date of Birth: ______/ ______/ ______Phone: ______Cell Phone: ______License #: ______Email: ______

Co-Applicant Information:

First Name: ______Last Name: ______SSN: ______Date of Birth: ______/ ______/ ______Phone #: ______Cell Phone #: ______License #: ______Email: ______

Others who will be living in this apartment:

Name: ______Relationship: ______Age: ___ Name: ______Relationship: ______Age: ___ Name: ______Relationship: ______Age: ___ Name: ______Relationship: ______Age: ___ Name: ______Relationship: ______Age: ___

Current Rental Information:

Address: ______Apt# ___ City: ______State: ____ Landlord’s Name: ______Landlord’s Phone #:______Lease Start Date: _____ / _____ / _____ Lease Termination Date: _____ / _____ / _____ Reason for Leaving: ______Name in which your utilities are now billed: ______

Rental History:

Address: ______Apt# ___ City: ______State: ____ Landlord’s Name: ______Landlord’s Phone #:______Move In Date: ______/ ______/ ______Move Out Date: ______/ ______/ ______Applicant’s Current Employment:

Company Name: ______Company Address: ______Supervisor’s Name: ______Supervisor’s Phone #: ______Date of Employment: ______/ ______/ ______to ______/ ______/ ______Position: ______Monthly Gross Income: ______Applicant’s Employment History:

(Complete if you have been employed at your current job for less than 1 year).

Company Name: ______Company Address: ______Supervisor’s Name: ______Supervisor’s Phone #: ______Date of Employment: ______/ ______/ ______to ______/ ______/ ______Position: ______Monthly Gross Income: ______Co-Applicant’s Current Employment:

Company Name: ______Company Address: ______Supervisor’s Name: ______Supervisor’s Phone #: ______Date of Employment: ______/ ______/ ______to ______/ ______/ ______Position: ______Monthly Gross Income: ______Co-Applicant’s Employment History:

(Complete if you have been employed at your current job for less than 1 year).

Company Name: ______Company Address: ______Supervisor’s Name: ______Supervisor’s Phone #: ______Date of Employment: ______/ ______/ ______to ______/ ______/ ______Position: ______Monthly Gross Income: ______Additional Income:

Income Source: ______Amount: ______Verification Contact: ______Phone #: ______Applicant’s Banking Information:

Bank: ______Account #: ______Amount: ______Bank: ______Account #: ______Amount: ______Co-Applicant’s Banking Information:

Bank: ______Account #: ______Amount: ______Bank: ______Account #: ______Amount: ______Applicant’s Personal References:

Name: ______Relationship: ______Phone #: ______Name: ______Relationship: ______Phone #: ______Name: ______Relationship: ______Phone #: ______Co-Applicant’s Personal References:

Name: ______Relationship: ______Phone #: ______Name: ______Relationship: ______Phone #: ______Name: ______Relationship: ______Phone #: ______Applicant’s Vehicle Information:

Make: ______Model: ______Year: ______Color: ______License Plate #: ______State of Registration: ______Co-Applicant’s Vehicle Information:

Make: ______Model: ______Year: ______Color: ______License Place #: ______State of Registration: ______Pet Information:

Type: ______Breed: ______Weight: ______Type: ______Breed: ______Weight: ______Emergency Contact Information:

Name: ______Relationship: ______Phone #: ______Name: ______Relationship: ______Phone #: ______Additional Information:

Have you ever been convicted of a crime? ______Describe and date each one: ______

Have you ever been evicted, declared ______Bankruptcy of had a judgment against ______you? Describe and date each one: ______

_____ I agree to the I represent that the information provided in this application is following statement true, complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission of information grounds for eviction.

_____ I agree to the I understand that the information provided might be used by the following statement Landlord to determine whether to accept this application. I authorize Landlord to verify all the information given in this application, including past rental information, personal references and employment information provided. I authorize Landlord to obtain a current credit and criminal background check.

_____ I agree to the I understand that this application is not a rental agreement and following statement that this application does not create any obligation on the Landlord.

_____ I agree to the I understand that if a court issues a warrant for my eviction from following statement these premises, my name, my co-applicant’s name, my address and possibly the reason for my eviction will be posted on the Kingston Landlord Support Services website.

Print Name: ______Signature: ______Date: ______