Rental Application

INSTRUCTIONS:
Please enter all information correctly
and completely. Missing, incomplete or fraudulent information is grounds for
rejection. In order to process your application quickly, please attach most
recent tax return or 4506T (IRS transcript), copies of picture ID for all
adults, and copies of social security cards for all family members. All
non-married adult applicants must complete separate applications. Mail or bring
the completed application to the address above (if you mail the application be
sure to let us know how to contact you). If you appear to be qualified based on
the information submitted, you will be asked to pay the Application Fee ($33
for each adult 18 or older and $13 for each 16-17 year old for most
properties). Do not enclose the fee with the application. For
Spokane Housing Ventures has a “no cash” policy . Make checks or money orders for screening fees out to T.I.S., the background screening service.
If
you need assistance completing this application or have any questions regarding
this form, the application process or a prospective unit, please contact resident services/occupancy manager at
(509)232-0170 Ext. 205.
Return to the Spokane Housing Ventures website
PROPERTY: I am interested in renting:
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Studio 1 BR |
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5th & |
Casas Salvadas |
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Willow Ridge |
El Estero |
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2BR 3BR |
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Hidden Pines |
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Scattered
Sites |
Hartson Triplex |
Village Apts. |
Bel |
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4 BR Other |
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Woodruff Hts. |
Landmark |
Green
Gables |
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APPLICANT
INFORMATION:
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Applicant Name: |
Jr. Sr. Etc.: |
Full Time Student: Yes
No |
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Current Address: |
Telephone: |
Rent Amount: |
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City, State, Zip: |
Date of Birth: |
Are you 18 or older? Yes
No |
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SSN: |
Have you ever used a different SSN or
last name? Yes
No |
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Driver's License # and State of issue: |
Email address: |
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Co-Applicant Name: |
Jr. Sr. Etc.: |
Full Time Student: Yes
No |
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Current Address: |
Telephone: |
Rent Amount: |
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City, State, Zip: |
Date of Birth: |
Are you 18 or older? Yes
No |
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SSN: |
Have you ever used a different SSN or
last name? Yes
No |
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Driver's License # and State of |
Email address: |
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Have you ever
lived in a property owned and/or managed by Spokane Housing Ventures Y
N
Property___________________________
OCCUPANT
INFORMATION: Please list names of other
occupants who will be living at this residence. Attach additional page if
necessary.
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Last Name |
First Name |
SSN |
Gender (circle) |
Birth Date |
Full Time Student? |
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M
F |
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Y
N |
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M
F |
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Y
N |
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M
F |
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Y
N |
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M
F |
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Y
N |
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M
F |
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Y
N |
RESIDENCE/RENTAL
HISTORY: List current address first. Provide at least 3 years of
rental history. Attach an additional
paper if necessary.
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Move In Date |
Move Out Date |
Property Address |
Rent |
Deposit |
Landlord/Owner Name |
Daytime Phone |
Reason For Leaving |
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EMPLOYMENT
REFERENCE: Please list your current
employer. If unemployed, state so.
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Current Employer |
Supervisor |
Phone |
Position |
How Long? |
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Applicant |
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Co-app. |
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INCOME: Please identify source, name of recipient and amount of current
income. Is your income seasonal or sporadic?
Yes No
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Applicant Current |
Recipient's |
Monthly |
Co-Applicant |
Recipient's |
Monthly |
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Employment |
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Employment |
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Child Support/Alimony |
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Child Support/Alimony |
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SSA |
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SSA |
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SSD |
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SSD |
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SSI |
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SSI |
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VA |
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VA |
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L&I |
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L&I |
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DSHS |
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DSHS |
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Food Stamps |
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Food Stamps |
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Other |
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Other |
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PERSONAL
REFERENCE/EMERGENCY CONTACT: Please list two personal references as well as an
emergency contact.
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Name |
Address |
Phone |
Relationship |
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Emergency Contact |
CURRENT
HOUSING, REFERRAL AND/OR SPECIAL NEEDS: Please
circle all that apply.
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Current Housing Type: |
Referred by: |
Special Housing Needs: |
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House |
Self |
Ground Floor |
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Doubled up with another family |
Sign for rent |
Wheel chair accessible |
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Transitional Housing Apartment |
Flyer or Newspaper |
Ramp |
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Shelter |
Church |
Barrier free |
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Homeless |
Housing Authority |
Hearing- or sight-accessible smoke detectors |
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Car/streets |
Social service staff |
English as a
second language |
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Outreach team |
Live-in caretaker |
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Apartment |
Alcohol/drug program |
Large Family (4 or more) |
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Other (Please
List) |
Mental health program |
Other (Please
List) |
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Emergency housing program |
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Other (Please List) |
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MISCELLANEOUS: Please answer all questions.
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Are you currently receiving a Section 8
voucher or certificate? |
Yes No |
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Have you or any member of your household
ever been evicted from your home? |
Yes No |
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Do you own a vacuum cleaner or do you have
access to one on a regular basis? |
Yes No |
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Within the last seven years, have you or any
member of your household filed bankruptcy? |
Yes No |
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If
yes, is the bankruptcy discharged? |
Yes No |
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Are you or any member of your household
currently having your wages garnisheed? |
Yes No |
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Have you or a household member ever been
charged with illegal manufacture or distribution of a controlled substance? |
Yes No |
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Have you or a member of your household ever
been convicted of a crime? |
Yes No |
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Describe Offense: |
Year convicted: |
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Are you or any member of your household a
registered sex offender in any state? |
Yes No |
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Are you or any member of your household
required to register your address with a corrections office or with police
personnel? |
Yes No |
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Do you own a pet? (Please inquire about our
pet policy.) |
Yes No |
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Do you own a waterbed? (Please inquire about
our insurance policy.) |
Yes No |
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VEHICLE INFORMATION:
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Year |
Make/Model |
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License Number |
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Auto #1 |
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Auto #2 |
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OPTIONAL INFORMATION: TO BE USED ONLY
FOR EQUAL OPPORTUNITY COMPLIANCE MONITORING PURPOSES. Spokane
Housing Ventures is committed to offering equal housing opportunities to
qualified individuals and families and does not discriminate with regard to
race, color, religion, national origin, sex, marital or familial status,
disability, veterans/military status or sexual orientation. Your answers
to these questions are optional and will be used only to help us determine our
compliance with equal opportunity guidelines.
APPLICANT:
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Gender: |
Male |
Female |
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Marital Status: |
Married |
Separated |
Single (Divorced, Widowed, Never Married) |
CO-APPLICANT:
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Gender: |
Male |
Female |
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Marital Status: |
Married |
Separated |
Single (Divorced, Widowed, Never Married) |
Release of Information, Disclosure and Authorization to Verify
In compliance with state and federal consumer reporting law, you are
hereby advised that a screening will be conducted regarding the information
contained in this application. The report may contain information regarding
your credit-worthiness, character, general reputation, personal characteristics
and mode of living. By signing this application, you authorize MOCO, Inc.,
whose address is
I (we) hereby authorize Spokane Housing Ventures to verify the information herein in order to evaluate my (our) eligibility for tenancy. I (we) understand that verification will require inquiries to past and present employers and other income sources, past and present landlords, and social service agencies. It may also require obtaining credit reports and examination of public records and databases. Credit reports and public records will be obtained from third party sources. I (we) understand that all information submitted herein and which Spokane Housing Ventures and/or MOCO may obtain from other sources for verification purposes will be held in strict confidence by Spokane Housing Ventures and MOCO, and not used for any purpose, or disclosed to any parties, not related to evaluating my (our) eligibility for tenancy.
I (we), ______________________________________________ understand that all information provided herein to Spokane Housing Ventures as part of my (our) application for tenancy will be thoroughly reviewed by staff and or their agents. I (we) hereby certify that this application has been made freely and voluntarily, and that the information entered above is accurate to the best of my (our) knowledge and the statements are true and complete. False, fraudulent or misleading information may be grounds for denial of tenancy or subsequent eviction.
Signature _____________________________________________________ Date ___________
Signature _____________________________________________________ Date ___________
To appeal or dispute the decision of