Waiting list Questionnaire/Pre-screener housing Done Wright LLC

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Questionnaire/Screener.

Questionnaire/Screener.

Questionnaire/Screener to Check if you meet are MIN requirements

32Questions

1
Select option
Need to call or text
Tenant
left message/text
Other
2
This is are Old Screener please click here to move to the new screener
okok
3
ARE YOU CURRENTLY LIVING AT ONE OF HOUSING DONE WRIGHT LOCATIONS* This field is required.
YESNO
4
Have you EVER been Convicted, Plead guilty to or No Contest to ANY Felonies* This field is required.Even if your Records was EXPUNGED
YESNO
5
DOES YOUR FELONY CONSIST OF ANY OF THE FOLLOWING MURDER, ARSON, SEX CRIMES, HATE CRIMES, AGGRAVATED DOMESTIC VIOLENCE, AND/OR A VIOLENCE CRIME* This field is required.
YESNO
6
Do you Approve of a Nationwide Background Check* This field is required.
YESNO
7
Housing Done Wright Does Not Accept ANY Animals in our Shared-living housing community.* This field is required.
I have no problems with thisNo
8
Do you have a history of any substance abuse problem. When was the last time you used?* This field is required.
No/Never
Week or less
Within the last 30 days But not in the last week
Within 6 month but greater then 1 Month
1 year or 6 months
over 1 year
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No/Never
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Week or less
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Within the last 30 days But not in the last week
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Within 6 month but greater then 1 Month
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1 year or 6 months
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over 1 year
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9
How often do you have a drink containing alcohol?* This field is required.
No/Never
Monthly or less
2-4 time a Month
2-3 times a week
4 or more times a week
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No/Never
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Monthly or less
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2-4 time a Month
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2-3 times a week
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4 or more times a week
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10
Do you Smoke Cigarettes* This field is required.
YESNO
11
Do you Smoke Medical Marijuana* This field is required.
YESNO
12
Will you pass a Drug Test (Not including Marijuana)* This field is required.
YESNO
13
Do you make up your Bed Everyday* This field is required.
YESNO
14
Please list any and all known behavior health issues
Huge
Large
Normal
Small
Ok
Ok
15
How often do you do Laundry * This field is required.
at least once a Week
at least once every 2 weeks
at least once a month
I Dont Know
Wash Clothes
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Wash Bedding
Row 1, Column 0
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Wash Clothes
Wash Bedding
at least once a Week
Row 0, Column 0
at least once every 2 weeks
Row 0, Column 1
at least once a month
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I Dont Know
Row 0, Column 3
at least once a Week
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at least once every 2 weeks
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at least once a month
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I Dont Know
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16
How would you rate your Hygiene when your in a stable environment * This field is required.
Poor
Fair
Average
Good
Excellent
Top Notch
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Poor
Row 0, Column 0
Fair
Row 0, Column 1
Average
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Good
Row 0, Column 3
Excellent
Row 0, Column 4
Top Notch
Row 0, Column 5
17
I like living in a....* This field is required.
Very Clean Space (Cleaned Daily)
Clean Space (Cleaned Weekly)
Messy Space
Indifferent (I don't care what condition my room is)
18
How would you rate your cleanliness 1-10* This field is required.10 being the highest
10
9-8
7-6
5-4
3-1
19
How do you feel about rules:* This field is required.
Rules are there to be followed 100% of the time
Rules are just guidelines and can sometimes be bent
In many situation, i don't feel like rules really apply to me
20
Have you ever been evicted.* This field is required.
YESNO
21
Do you have a steady source of income* This field is required.
YESNO
22
Main source of income* This field is required.
SSI
SSDI
Employed
Self-employed
23
Monthly income amount
24
Are you okay with Helping Cleaning Common Areas* This field is required.
YESNO
25
housing points
26
Name* This field is required.
First Name
Last Name
27
Phone Number* This field is required.
28
Want Type of Room are you looking for* This field is required.
As soon as anything opens up (doesn’t matter private or shared) for 1 person max
Shared room (two HDW guest sharing one room for 1 person max)
Private room (for one person in a private room)
Large room/couples room( for 1 or 2 people max)
Other
29
If a shared room becomes available, would you be comfortable sharing the room with a person of the opposite gender?* This field is required.
Yes, Wouldn’t be a problem
Maybe
Absolutely Not -Same gender only
30
Name of second individual* This field is required.
First Name
Last Name
31
Phone Number of Second individual* This field is required.
Area Code
Phone Number
32
Use the space to add any more information about your housing needs
33
How did you here about Us* This field is required.
34
How soon are you needing a place?* This field is required.Everything is done on the first come first serve basis and availability
Date
Month
Day
Year
35
Date
Date
Month
Day
Year
11
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Hour
28
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59
Minutes
PM
AM
PM
36
Thank you, for you interest, however currently you DO NOT qualify for any of our properties.
Should be Empty:

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