Connecticut Rental Application Template

Transcript

RENTAL APPLICATION 4/04 - CONNECTICUT DEPARTMENT OF TRANSPORTATION Applicant __________________________ Date of Birth ____________________________ Social Sec. # ______________________ Driver's License #________________________ Address _______________________________________________________________________ Home Tel. # ________________________ Work Tel. # ______________________________ Do you rent or own? __________ Amount of mo. rent or mortgage:_________________ Current Landlord/Mortgagee Name ______________________________________ Tel. #_____________________________ Address________________________________________________________________________ Reason for leaving_____________________________________________________________ How long have you lived at your present address*_______________________________ * If less than 3 years, add sheet with information on prior residence(s) Current Employment Employer __________________________________ Tel. #_____________________________ Address________________________________________________________________________ Position _________________ Income _______________ How long employed*___________ * If less than 3 years, add sheet with information on prior employment Present U.S. Military Status___________________________________________________ Other Income___________________________________________________________________ Total Household Income_________________________________________________________ Total number of vehicles (including Company Cars)______________________________ Type __________________________ Year _____ Tag No.________________ State_______ __________________________ _____ ________________ _______ __________________________ _____ ________________ _______ Credit Cards - Mortgage - Car Loans Name Account No. Balance ____________________________ _____________________ _____________ __________ ____________________________ _____________________ _____________ __________ ____________________________ _____________________ _____________ __________ Mo.Pymnt. Checking Account: Bank, Address, Account Number and Balance _______________________________________________________________________________ Savings Account: Bank, Address, Account Number and Balance _______________________________________________________________________________ Additional Personal References Name Relationship __________________________________ ___________________ _____________________ __________________________________ ___________________ _____________________ __________________________________ ___________________ _____________________ Telephone Have you been bankrupt in the past seven years?________________________________ Are you obligated to pay alimony or child support?_____________________________ Have you ever been evicted or asked to leave a rented unit?____________________ Have you ever not paid rent when due?__________________________________________ Have you ever had any criminal convictions? Yes No If yes, give details. _______________________________________________________________________________ Parole Officer's Name__________________________________________________________ Parole Officer's Telephone No._________________________________________________ Other Occupants Total number to occupy unit_________________________________ Names, ages and relationship to applicant______________________________________ _______________________________________________________________________________ (All occupants over age 18 should complete a separate application.) Pets (type, breed and age)_____________________________________________________ Geographic Location Preference 1._______________________2._____________________ Address of State Property______________________________________________________ Rental Offer Per Month_________________________________________________________ Additional Information: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I/We declare the foregoing information is true and correct, and I/We hereby authorize the Connecticut Department of Transportation to conduct a landlord, criminal, and credit check and to verify our employment and references. Signature ______________________________________ Date__________________________ Signature ______________________________________ Date__________________________