APPLICATION QUALIFICATION FORM
Several criteria are considered while determining whether to approve a new tenant. Many of these criteria are built into a process.
Checks may be made on the prospective tenant’s employment or other sources of income, credit history, criminal history, rental history,
references, credit sources, banks and other financial institutions, and previous employers. While not all of these are checked on each
prospective tenant, you should be prepared to disclose all of the above information and have it checked and verified.
The undersigned prospective tenants certify and warrant that:
1. All of the prospective tenants have verifiable sources of income, verifiable past rental history, and verifiable credit and
references, each occupant/tenant/resident is residing in the United States legally, and that the information above is accurate.
2. None of the prospective tenants/occupants (even minors) have ever been evicted from a premises, have a current outstanding
judgment, have left a previous landlord owing money, or have left a prior rental premises under threat of eviction.
3. None of the prospective tenants/occupants (even minors) have ever filed for bankruptcy protection whether or not the
bankruptcy was discharged or dismissed, have a current pending bankruptcy case, or have met with a bankruptcy attorney in the last two
years. If any have filed or met with a bankruptcy attorney, please give details (include date of bankruptcy, attorney name, etc.):
4. None of the above prospective tenants/occupants (even minors) have ever been convicted any crime other than a minor traffic
violation, except those disclosed below (include type of criminal act, place of occurrence, date of occurrence, resulting action, and current
status (probation, parole, etc.):
5. None of the prospective tenants/occupants (even minors) have ever committed, been indicted, arrested, investigated, or
otherwise detained for any criminal act (other than a minor traffic infraction); except those disclosed below (include type of criminal act,
place of occurrence, date of occurrence, resulting action, and current status (probation, parole, etc.):
In the event Owner/Landlord proceeds with an application and it is determined that the prospective tenants have been
untruthful in any of the above statements, each undersigned prospective tenant agrees to pay to Landlord the actual costs incurred in
processing the application and an administrative fee of $100.00.
The Undersigned represent that all of the above statements are True and Complete and hereby AUTHORIZE VERIFICATION
OF SUCH INFORMATION . Authorization is given to contact any REFERENCES, BANK, PRIOR LANDLORDS, PRIOR/CURRENT
EMPLOYERS, GOVERNMENTAL AGENCIES, AND FAMILY. Further authority is given to check all CREDIT AND PUBLIC
RECORD INFORMATION. Applicants release ALL liability or responsibility, from all person or corporations that request or supply
such information. Applicant acknowledges that FALSE information herein will constitute grounds for: (1) Rejection of an application,
(2) Termination of resident’s right to OCCUPANCY and eviction. False information may also constitute a serious offense under the laws
of the state.
Dated this
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© Kirk A. Cullimore 5/2008 This form may not be reproduced without express written permission.
