Residential Rental Application
This Residential Rental Application (the "Application") is submitted by [Applicant full legal name] ("Applicant") to [Landlord or manager name] ("Landlord") for the rental of the dwelling at [Property applied for (including unit)] (the "Property") at a monthly rent of [Monthly rent], with a desired move-in date of [Desired move-in date]. Applicant provides the information below so that Landlord can evaluate this Application, and authorizes Landlord to verify it as Section 8 describes. Each adult who will live in the Property must submit a separate application.
1. Applicant
Full legal name: [Applicant full legal name]. Other names used in the last seven years: [Other names used in the last 7 years (or "None")]. Telephone: [Applicant phone]. Last four digits of Social Security number: [Last four digits of Social Security number]. Applicant will show the following government-issued photo identification to Landlord and will provide the full Social Security number or taxpayer identification number directly to Landlord’s screening service on its secure form: [Government photo ID to be shown]. Landlord will not record the full number, date of birth or identification number on this Application.
2. Residence History
Current address: [Current address], occupied [Dates at current address], at a monthly rent of [Current monthly rent]. Current landlord or manager: [Current landlord or manager: name and phone]. Reason for leaving: [Reason for leaving].
Previous address and dates: [Previous address (or "None")]. Previous landlord or manager: [Previous landlord: name and phone (or "None")]. Applicant authorizes each current and previous landlord to disclose to Landlord the dates of tenancy, rent paid, payment history, any notices served, the condition of the premises at move-out and whether the landlord would rent to Applicant again.
3. Employment and Income
Current employer: [Current employer]. Position: [Position]. Employer address and telephone: [Employer address and phone]. Length of employment: [Length of employment]. Gross monthly income from employment: [Gross monthly income from employment]. Other income Applicant wishes to have considered, with its source: [Other income you want considered (or "None")]. Applicant authorizes the employer to confirm the position, dates of employment and income stated, and agrees to provide, on request, recent pay stubs, an offer letter, tax returns or bank statements sufficient to verify income. Where the law of the State of [Governing law (state)] or a local ordinance treats source of income, including housing assistance, as a protected characteristic, Landlord will consider all lawful, verifiable income on the same basis.
4. Occupants, Pets and Vehicles
All persons other than Applicant who will live in the Property, with their relationship to Applicant and, for minors, their ages: [Everyone else who will live in the unit (or "None")]. Pets: [Pets: type, breed, weight (or "None")]. An assistance animal needed because of a disability is not a pet, is not subject to any pet restriction, deposit or fee, and need not be listed here; Applicant may request an accommodation separately. Vehicles to be parked at the Property: [Vehicles: year, make, model, plate (or "None")]. Does anyone in the household smoke: [Does anyone in the household smoke?].
5. References and Emergency Contact
Personal reference (not a relative): [Personal reference: name, relationship, phone]. Emergency contact: [Emergency contact: name, relationship, phone]. Applicant authorizes Landlord to contact the reference about Applicant’s suitability as a tenant, and consents to Landlord contacting the emergency contact in the event of an emergency at the Property or if Applicant cannot be reached after becoming a tenant.
6. Additional Disclosures
Has Applicant ever been evicted, or had a judgment for possession or unpaid rent entered against Applicant: [Have you ever been evicted or had an eviction judgment against you?]. Explanation of any answer above, including the date, the outcome and the circumstances, which Landlord will take into account: [Explanation (or "None")]. Landlord does not ask about arrests, and asks about convictions, if at all, only to the extent and at the stage that the law of the State of [Governing law (state)] and any local ordinance permit; where an individualized assessment is required before a conviction may be considered, Landlord will conduct one.
7. Application Fee; Holding
Applicant has paid an application fee of [Application fee (or $0)], which covers Landlord’s actual cost of obtaining consumer reports and verifying this Application, is limited to any maximum set by the law of the State of [Governing law (state)] or local ordinance, and is non-refundable except to the extent that law requires a refund of any part not spent on screening. If that law requires an itemized receipt of screening costs, Landlord will provide one. Submission of this Application and payment of the fee do not reserve the Property, do not create a tenancy, and do not obligate Landlord to rent to Applicant. The Property is reserved only when a lease is signed and any holding deposit Landlord separately agrees to accept is paid, and a holding deposit is governed by its own written receipt.
8. Authorization and Consent to Screening
Applicant authorizes Landlord and any tenant-screening company or consumer reporting agency acting for Landlord to obtain a consumer report and an investigative consumer report about Applicant for the purpose of evaluating this Application, as permitted by the Fair Credit Reporting Act, 15 U.S.C. §1681 et seq., and to obtain Applicant’s credit history, rental history, eviction records, and, to the extent the law permits, criminal background records, and to verify every statement in this Application with the landlords, employers, references and institutions named. This authorization continues for the duration of any tenancy that results, for the purpose of collecting amounts owed under the lease, to the extent the law allows. Applicant understands that if Landlord takes adverse action based in whole or in part on a consumer report, Landlord will provide the notice the Fair Credit Reporting Act requires, including the name of the reporting agency and Applicant’s right to obtain a free copy of the report and dispute its accuracy. Applicant may request a copy of the nature and scope of any investigative consumer report.
9. Certification
Applicant certifies that every statement in this Application is true, complete and accurate. Applicant understands that Landlord will rely on it, that any false, incomplete or misleading statement is grounds for denying this Application, and that if a false statement is discovered after a lease is signed it is a material breach of the lease and grounds for termination to the extent the law of the State of [Governing law (state)] allows. Applicant agrees to notify Landlord promptly of any change to the information in this Application before a lease is signed.
10. Equal Housing Opportunity; Screening Criteria
Landlord complies with the federal Fair Housing Act and all state and local fair housing laws and does not discriminate on the basis of race, color, religion, national origin, sex, familial status, disability, or any other characteristic protected by law. Landlord applies the same written screening criteria to every applicant, in the order applications are received, and will provide those criteria on request or as the law requires. An applicant with a disability may request a reasonable accommodation in the application process or in the rules, policies or physical features of the Property at any time. Landlord will keep this Application, whether approved or denied, for at least two (2) years and will protect the personal information in it as the law requires.
11. Signatures; Receipt
This Application may be signed electronically, and the electronic execution record kept by the signing platform, including the time Applicant signed, is conclusive evidence of when this Application was submitted and of Applicant’s authorization in Section 8. Applicant’s signature confirms the certification in Section 9 and the authorization in Section 8. Landlord’s signature acknowledges receipt of this Application and of the application fee stated in Section 7 on the date shown in the execution record, and does not constitute approval of the Application or an agreement to rent the Property.
Signatures
Landlord or Manager · Applicant