2016 Chicago Lease Application
The Chicago Association of REALTORS® fully supports the practice of equal opportunity in Fair Housing.
As a REALTOR®, following is information which you need to know when using the attached Lease Application
to screen of potential tenants.
In response to a disparate impact Fair Housing Act claim which was heard by the Supreme Court, the United
Stated Department of Housing and Urban Development (HUD) issued guidance titled “Office of General Counsel
Guidance on Application of Fair Housing Standards to the Use of Criminal Records by Providers of Housing and Real
Estate-Related Transactions.” While persons with criminal records are not a protected class under the Fair Housing Act, in
this guidance HUD cautioned that blanket policies could violate the Fair Housing Act if they deny persons housing based
on (i) a prior arrest without a conviction or (ii) a prior conviction “no matter when the conviction occurred, what the
underlying conduct entailed, or what the convicted person has done since then.” Those using the attached form should
review HUD’s guidance carefully before requesting an applicant’s criminal history information.
Those using the attached Lease Application should also be aware that Cook County’s Human Rights
Ordinance also prohibits discrimination against Section 8 voucher holders. Violating federal, state, or
local fair housing laws is a serious offense and as a REALTOR®, could also rise to the level of an
Article 10 violation of the REALTORS® Code of Ethics, which provides that it is a violation to deny
equal professional services to any person for reasons of race, color, religion, sex, handicap, familial
status, national origin, sexual orientation, or gender identity.
V1.0%06/2016% Page%1%of%2%
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LEASE%APPLICATION%
©"2016"by"Chicago"Association"of"REALTORS®"-"All"rights"reserved"
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Each"co-applicant"and"occupant"18"years"or"older"must"submit"a"separate"application%
Property%Address:%___________________________________________________________________________________%
Requested%Lease%Start%Date:%_______________%Requested%Lease%Term:%_______________%Monthly%Rent:%$__________%
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Ex:%1%year,%18%months,%etc…%
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Applicant’s%Name%(first,%middle ,%last)%__ __ __ ______________________________________________________________%
% Is%there%a %co -applicant?%□%yes%%□%no%%if"yes,"co-applicant"must"submit"a"separate"application%
Social%Security%No.%_________/_________/_________%%Date%of%Birth:%_________/_________/_________%
Driver%License%No.%_________________________________________%in%______(state)%
E-mail:%__________________________________________%Home%Phone:%______________________________________%
Mobile%Phone:%____________________________________%Work%Phone:%______________________________________%
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Name%of%ALL%other%persons%who%will%occupy%the%Property:%
Name:%________________________________________%Relationship:__________________%DOB:%__________________%
Name:%________________________________________%Relationship:__________________%DOB:%__________________%
Name:%________________________________________%Relationship:__________________%DOB:%__________________%
Name:%________________________________________%Relationship:__________________%DOB:%__________________%
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Emergency%Contact%Information:%%
Name:______________________________%Relationship:_______________________%Phone:______________________%
Address:%__________________________________________________________________________________________%
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Applicant’s%Current%Address:%
_______________________________________________%
__________________________________(city,%state,%zip)%
Landlord’s%Name:%________________________________%
Landlord’s%Phone:%________________________________%
Landlord’s%E-mail:%________________________________%
%%*Moved-In%Date:%%%%%%%%%%%%%%%%%%%%%%%%%Move-Out%Date:%%
%_______________%%%%%%%%%%%%%%%%%%%%%%______________%
*If%less%than%two%years,%also%complete%Previous%Address%
Monthly%Rent:%$__________________%
Reason%for%moving:%_______________________________%
Applicant’s%Previous%Address:%
_______________________________________________%
__________________________________(city,%state,%zip)%
Landlord’s%Name:%________________________________%
Landlord’s%Phone:%________________________________%
Landlord’s%E-mail:%________________________________%
%%%Moved-In%Date:%%%%%%%%%%%%%%%%%%%%%%%%%Mo ve-Out%Date:%%
%_______________%%%%%%%%%%%%%%%%%%%%%%______________%
Monthly%Rent:%$__________________%
Reason%for%moving:%_______________________________%
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Applicant’s%Current%Employer:%%
_______________________________________________%
Address:%_______________________________________%
_______________________________________________%
Supervisor’s%Name:%______________________________%%
Supervisor’s%Phone:%______________________________%
Supervisor’s%E-mail:%______________________________%
*Start%Date:%_____________%%Position:_______________%
Gross%Monthly%Income:%$__________________________%
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Applicant’s%Previous%Employer:%%
_______________________________________________%
Address:%_______________________________________%
_______________________________________________%
Supervisor’s%Name:%______________________________%%
Supervisor’s%Phone:_______________________________%
Supervisor’s%E-mail:%______________________________%
Start%Date:%______________%End%Date:%______________%
Gross%Monthly%Income:%$__________________________%
*If%less%than%two%years,%also%complete%Previous%Employer%
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Other%Income:%
Source:%________________________%Amount:%$____________%When/How%often%received:%_______________________%
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V1.0%06/2016% Page%2%of%2%
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List%All%Pets%(if%permitted)%to%be%kep t%on %the%P rop erty%(d ogs ,%cats,%birds,%etc…):%%%%%%%%%%%%Spayed%or%%%%%%%%%%%%%%%%%%%%%%%%%%%Rabies%Shot%
Type%&%Breed%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Color%%%%%%%%%%Weight%%%%%%%%%%Age%%%%%%%%%%Gender%%%%%%%%%%%%Neutered?%%%%Declawed?%%%%%%Current?%
_________________________________________________________________%%%%%%□%yes%%□%no%%%%□%yes%%□%no%%%%□%yes%%□%no%
_________________________________________________________________%%%%%%□%yes%%□%no%%%%□%yes%%□%no%%%%□%yes%%□%no%
_________________________________________________________________%%%%%%□%yes%%□%no%%%%□%yes%%□%no%%%%□%yes%%□%no%
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Yes%
No%
Explanation%(If%answered%yes)%
Will%any%waterbeds%or%water-filled%furniture%be%on%the%pro p ert y?%
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Does%anyone%who%will%occupy%the%property%smoke?%
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Has%Applicant%ever:%
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%%%%%had%a%notice%of%eviction%filed%against%them%in%the%las t%7 %ye a rs?%
%%%%%%%%if"yes,"provide"year"and "e xp la na t ion"
□%
□%
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%%%%%breached%a%lease%or%rental%agreement?%
"""""""""""if"yes,"provide"year"and "e xp la na tio n%
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%%%%%filed%for%bankrup tcy %in%the%las t%7 %ye a rs?%
%%%%%%%%if"yes,"provide"year"and "e xp la na t ion"
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%%%%%lost%prop e rty %in %a%fo r ec lo su re ? %
"""""""""""if"yes,"provide"year"and"explanation %
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Is%there%additional%information%Applicant%wants%considered?%
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Personal%or%Professional%References:%%
Name:%____________________________%Relationship:%______________%Phone/E-mail:%__________________________%
Name:%____________________________%Relationship:%______________%Phone/E-mail:%__________________________%
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Authorization%&%Notification:%%Applicant%authorizes%Landlord%and%Landlord’s%Representative%to:%(1)%obtain%a%copy%of%
Applicant’s%credit%report;%(2)%obtain%a%criminal%back g ro u nd %c h ec k%r ela te d %to %A p p lic an t ; %(3)%verify%any%renta l,%em plo yment,%
eviction,%or%criminal%history%or%verify%any%other%information%related%to%this%Application%with%persons%knowledgeable%o f%
such%information;%and%(4)%relea s e%t h is%A p plication %a n d %a n y %in fo rmation %c o n ta in e d %h e re in %in %fu r th e ra n ce %o f%t h e se %
purposes.%Applicant%represents%that%the%statem e nts%in%th is%Application%are%true%and%complete.%Applicant%understands%
that%submitting %this%Application%does%not%guarantee%acceptance%and%that%providing%false%or%inaccurate%information%is%
grounds%for%rejection%and%a%breach%of%any%lease.%Applicant%understa n d s%le a se %d o cu ments%may%be%s ig n ed %e le ctr on ic a lly. %
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_______________________________________________________________%%%%%%%%%%%%%%%%%___________________________%
Applicant’s%Signature%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Date%
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Applicant%submits%a%non-refundable%ap plication%fee%of%$_________%for%processing%and%reviewing%this%Application.%
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□%Paid%by%Check%%%%%%%%□%Paid%in%Cash%
or%
Check"One:%%□%Visa%%%%□%Master%Card%%%%□%American%Express%%%%□%Discover%%
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_____________________________________________% % _______________________________________%
Name%as%it%appears%on%card%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% % Billing%Address%
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_____________________________________________% % _______________________________________%
Card%Number%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% % Billing%City,%State%Zip%%%%%%%%%%%%%%%%
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%%%%%%%%%%%%%Expiration%Date%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Security%Code%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
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