Forms and Policies - Distinctive Rental Properties of Lafayette, Indiana

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APPLICANT	CO-APPLICANT
First Name*
Last Name*
Social Security Number*
Driver's License Number*
State of Issue*
Date of Birth*
Phone Number (xxx-xxx-xxxx)*
Email Address*
Vehicle Make (ie. Toyota)*
Vehicle Model*
License Plate Number*
State of Issue*
Current Address*	Permanent Address
Current City*	Permanent City
Current State*	Permanent State
Current Zip Code*	Permanent Zip Code
Current Landlord Full Name*
Current Landlord Phone Number*
OCCUPANCY
Number of Adults to Occupy Premises*	Number of Minors to Occupy Premises

EMPLOYMENT INFORMATION
APPLICANT	CO-APPLICANT
Currently Employed
Date You Can Start
Do You Have a Valid Driver's License?
May We Contact Your Employer?
Employment History List your last two employers, starting with the most recent one first
Employer 1	Employer 2
Employed From	Employed From
Employed To	Employed To
Name of Employer	Name of Employer
Address of Employer	Address of Employer
Job Title	Job Title
Salary (monthly gross)	Salary (monthly gross)
Reason For Leaving	Reason For Leaving
IN CASE OF EMERGENCY Give the names of persons not related to you whom you have known at least one year
APPLICANT EMERGENCY CONTACT
Name	Email Address*
Phone Number	Number of Years Known
CO-APPLICANT EMERGENCY CONTACT
Name	Email Address
Phone	Number of Years Known
PET INFORMATION
Pet Name	Pet Name
Type/Breed	Type/Breed


DISCLOSURES
Have you ever been evicted from any rental premises or willfully and intentionally refused to pay rent when due? YesNo	If Yes, explain:
Are there any circumstances that may interrupt your income or ability to pay rent?* YesNo	If Yes, please explain
Did You Graduate?	Subjects Studied
College Information
Name and Location	Years Attended
Did You Graduate?	Subjects Studied
General Information
List Hobbies, Sports, Extracurricular Activiies and Club. Please list length of time and leadership positions.
Referred By
Authorization I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representive. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
I have read, understood, and agree to these terms and conditions.

* Required

APPLICANT

Employment History

Employer 1

Employer 2

IN CASE OF EMERGENCY

PET INFORMATION

DISCLOSURES

College Information

General Information

Authorization