Room Rental Application
Please complete this form with your personal details, assistance information, occupancy plans, and background check consent. To help ensure a smooth application process, please have the following information and documentation available before completing your rental application. A valid government issued photo ID (such as a Driver's License, state identification card, Military ID, passport or other acceptable identification) Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN), if applicable.
Eligibility Criteria
Income History: Applicants must demonstrate a monthly income of at least two times the monthly rent. Provide paystubs, LES, or bank statements to show self-employment income. Background and credit history will be reviewed on a case-by-case basis. Any prior evictions or criminal history will be taken into consideration during the application process.
Full Name
*
First Name
Middle Name
Last Name
Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN)
*
Date of Birth
*
-
Month
-
Day
Year
Date
Driver's License / State ID Number
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you currently unemployed?
*
Yes
No
Types of economic assistance you are currently receiving (select all that apply)
Unemployment Benefits
Supplemental Nutrition Assistance Program (SNAP)
Temporary Assistance for Needy Families (TANF)
Medicaid
Other
Are you currently receiving Social Security?
*
Yes
No
Are you currently receiving Social Security Disability Insurance (SSDI)?
*
Yes
No
Are you currently receiving income from Veterans Affairs?
*
Yes
No
PROPOSED OCCUPANT(S): Please list all individuals who will reside in the shared room
*
Self
Additional Occupant (significant other, friend, child, coworker, relative)
Background Check: Do you anticipate that any of the following items may appear on your background report? (Criminal background check only, this is not a credit check)
*
Criminal Convictions: Felony or Misdemeanor
Pending Criminal Charges
Prefer not to disclose
None of the above
EMPLOYMENT INFORMATION
Current Employer
*
Position / Title
*
Employer Address
*
Supervisor Name
*
Supervisor Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Length of Employment
*
Gross Monthly Income
*
Additional Sources of Income (optional)
RENTAL HISTORY
Property Type:
Apartment
Condominium
Home
Other
Current Landlord - Name
Current Landlord - Address
Current Landlord - Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Landlord - Monthly Rent
Current Landlord - Dates of Tenancy (Start Date)
-
Month
-
Day
Year
Date
Current Landlord - Dates of Tenancy (End Date)
-
Month
-
Day
Year
Date
EMERGENCY CONTACT
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Please be advised that a copy of a valid government-issued photo identification, such as a state ID card or driver's license, is required to process your application. Applications submitted without valid identification will be considered incomplete and cannot be reviewed or processed until the required documentation is received.
Upload a picture of government-issued ID (State ID, Driver's License, Military ID or Passport)
Upload a File
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APPLICANT CERTIFICATION AND AUTHORIZATION TO VERIFY INFORMATION
I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that providing false, incomplete, or misleading information may result in denial of my application or termination of tenancy if discovered after occupancy. I also authorize Noni E Gene LLC and its designated representatives to verify information contained in this application, including employment, income, rental history, and other information necessary to evaluate my eligibility for tenancy, as permitted by law.
Applicant Signature
Applicant Signature Date
-
Month
-
Day
Year
Date
Electronic Signature
I consent to the use of electronic records and electronic signatures and agree that my electronic signature is legally binding and enforceable under applicable California law.
Electronic Signature
Electronic Signature Date
-
Month
-
Day
Year
Date
Submit Application
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