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License
Plate # State
Dr. License # |
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Bank
Branch Account# Type
of Account |
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OTHER
PERSONS TO OCCUPY RENTAL UNIT: |
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Name Age
Relationship |
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Name Age
Relationship |
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Name Age
Relationship |
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Emergency
Notify Relationship
Ph. |
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Address
Work Ph. |
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LAST 2
PLACES OF RESIDENCE: At least 1 1/2 years desired. Current
and Previous required (in detail please). |
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Current:
Date fromto
Rented
Owned
Paid per month. |
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Apartment
Name Address
Apt. No. |
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City
State Zip Code
Landlord Name Ph.# |
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Previous:
Date fromto
Rented
Owned
Paid per month. |
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Apartment
Name Address
Apt. No. |
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City
State Zip Code
Landlord Name Ph.# |
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EMPLOYMENT:
At least 1
1/2 years desired. Current and Previous required. Military
Self-Employed |
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CURRENT:
Fromto
Shift |
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Applicant's
Employer Address
How Long |
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Position
Salaryper
SupervisorPh# |
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Spouse's
Employer Address
How Long |
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Position
Salaryper
SupervisorPh# |
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SELF-EMPLOYED:
Bus. License# Bus.
Address |
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Length of
Ownership Leaser or
Landlord Name Ph# |
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PETS:
Number Type
Weight Age
Deposit |
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Have you
ever been served an EVICTION?
Date Address or Place |
Comments
or Declaration of any other relevant history: (Only text showing
on screen will print.)
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IMPORTANT:
READ CAREFULLY BEFORE SIGNING |
| CERTIFICATION:
I, the undersigned, hold harmless and release any employer,
landlord and/or Central Referral Service or its representatives
thereof from any and all liability for any damage or injury whatsoever
caused from issuing all background information including, but
not limited to, credit, rent history, and/or criminal
record. I further understand and agree that a false
statement herein is grounds for denial of employment, credit or
rental and basis for expulsion thereby. The correctness of
the above statements and verifications of same are to be
construed as condition precedent to any binding contract or
agreement between myself as applicant, and the grantor.
Applicant acknowledges and represents that all of the above
statements are true and complete and further that false
information herein may constitute grounds for rejection and/or
forfeiture of deposits and many constitute a criminal offense
under the laws of this state. By signing below, I warrant
that I agree to issuance of all reports, and have read and
understand and agree to the above. |
| Applicant's
Signature: |
Date: |
| Spouse's
Signature: |
Date: |
|
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| Fees/Deposits:
Cleaning Fee
Security
Application Process Fee(Non-Refundable) |
| Witness
Signature: |
Approved/Disapproved
by |
Date |
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