Apply – Slate and Steel Homes

Name *

First

Last

Phone Number *

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

How many months have you lived at this address? *

Do you own or rent? *

Own
Rent

Monthly cost of rent/mortgage

If you are renting, was proper notice given?

No
Yes

... Was home left in good condition?

No
Yes

... Was security deposit returned?

No
Yes

... Was balance due?

No
Yes

Landlord's name

First

Last

Landlord's phone number

If you have a vehicle, please describe

Employment *

Occupation *

Supervisor *

First

Last

Supervisor Phone Number *

Placement Agency

Placement Agency Phone Number

Contract Length (months) *

Desired Move-in Date *

Desired Move-out Date *

Have you ever been convicted of a crime? *

No
Yes

If "Yes," please describe

Have you ever filed for bankruptcy? *

No
Yes

If "Yes," please describe

Have you ever been evicted? *

No
Yes

If "Yes," please describe

Consent and Acknowledgment *

I agree

Applicant hereby certifies to being at least 18 years of age. Applicant represents that all information given on this application is true and correct. Applicant hereby authorizes verification of all references and facts, including but not limited to landlords, employers and references. Applicant agrees to credit and background checks through KeyCheck. Applicant agrees to provide a copy of employment contract upon request. Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing which may result in denial of tenancy. Applicant understands that if information is found to be incorrect after a lease agreement has been signed, the agreement would be in default. Applicant hereby waives any claim and releases from liability any person providing or obtaining said verification or additional information.

Signature *

Clear Signature