HOUSING INFORMATION

HOUSING INFORMATION
Unless assistance through a representative is required, all adults over the age of eighteen (18) who plan to remain at the premises must complete their own application. Please fill out this form with all the requested information. Before any party can sign a rental agreement, an application must be approved b an SCCL representative. We appreciate your interest in SCCL.
Please let us know how you heard about us:

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APPLICATION FORM
Name*

First NameMiddle Name
Last Name
Other Names Used
Date of Birth *

MonthDayYear
Date
Social security *
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Driver's License

NumberState
Vehicle

Make/ModelYear/Color
Do you smoke*

YesNo
Do you have any special needs or requirements that we need to be aware of?*

YesNo
If yes, please be specific:

Do you have any pet?*

YesNo
*** PET'S ARE NOT ACCEPTED, TENANTS WILL BE

FINED FOR ANY PET FOUND ON THEIR PREMISES AND

SUBJECT TO EVICTION ***

$150. 00 PET FINE WITH 72 HOURS REQUEST TO

REMOVE PET OR FACE EVICTION
Have you intentionally or willfully refused to pay rent when due?*

YesNo
Have you ever been subjected of an eviction proceeding or settlement whether or not a suit was actually filed?*

YesNo
If yes to either, please explain, including dates rental premises address and contact information for property owner and property manager :

CRIMINAL HISTORY
Have you or any other intended occupant, including minors, ever been convicted of or pleaded guilty or "no contest" to a misdemeanor involving sexual misconduct or the manufacturing of drugs whether or not resulting in a conviction?*

YesNo
Have you or any other intended occupant, including minors, ever been convicted of or pleaded guilty or been charged (whether or not resulting in a conviction or pleaded guilty or "no contest" to a felony?*

YesNo
Have you or any other intended occupant, including minors, required to register as a Violent or Sex Offenders in any jurisdictions*

YesNo
Do you agree to a civil and criminal background check? All potential are required to submit a police report from the current county of residence*

YesNo

EMPLOYMENT INFORMATION

(Current and Most Recent, at least 1 year employment)
Present employer *
City*
State*
Position *
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Monthly Income *
Supervisor *
Phone Number
Please enter a valid phone number.
OTHER INCOME

Include financial aid, social security, loans, mutual funds,stocks, bonds, family assistance, etc
SourceAmount per month

Emergency Contact

(Someone who is NOT already on the lease)
Name*

First NameLast Name
Relationship *
Phone Number*
I herby certify that the answers I have given in the application are true to the best of my knowledge. I understand that any false answers and statements made by me will be sufficient grounds for eviction and loss of any security deposit. I agree to a credit check if deemed necessary. I agree that my present and formal landlord may release information related to my tenancy with them, to the landlord. I agree that my present employer may release information related to my current income status to my landlord. It is understood that I will not be discriminated against based on race, color, sex, religion or national origin.
APPLICANT'S SIGNATURE
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BLESSED GATES

980-636-2053
CEO: AMETHYST STATON

EMAIL: Blessedgates12@gmail.com

LOCATION: UNDISCLOSED FOR SAFETY PURPOSES
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APPLICATION FORM