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: ___

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: ______

Co-Applicant’s Banking Information:

Bank: ______Account #: ______Amount: ______

Applicant’s Personal References:

Name: ______Relationship: ______Phone #: ______

Co-Applicant’s Personal References:

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: ______

Emergency Contact Information:

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: ______