Firefly Housing Rental Application
Name - Primary Occupant (required)
*
First Name
Last Name
Social Security Number (required)
*
Driver's License Number
Birth Date (required)
*
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January
February
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Day
Please select a year
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1920
Year
Cell Phone Number
-
Area Code
Phone Number
Home Phone Number
-
Area Code
Phone Number
Email (required)
*
example@example.com
ADDITIONAL OCCUPANTS
Name (Additional Adult Occupant)
First Name
Last Name
Social Security Number
Driver's License Number
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Cell Phone Number
-
Area Code
Phone Number
Home Phone Number
-
Area Code
Phone Number
Email
example@example.com
Name (Additional Occupant)
First Name
Last Name
Name (Additional Occupant)
First Name
Last Name
Name (Additional Occupant)
First Name
Last Name
RENTAL RESIDENCE HISTORY
CURRENT ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dates of Residency
Current monthly rent amount
Reason for leaving
Is rent paid up to date?
YES
NO
Did you give notice?
YES
NO
Were you asked to leave?
YES
NO
Name that your current utilities are billed to
PREVIOUS ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dates of Residency
Monthly rent amount
Reason for leaving
Is rent paid up to date?
YES
NO
Did you give notice?
YES
NO
Were you asked to leave?
YES
NO
PRIOR ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dates of Residency
Monthly rent amount
Reason for leaving
Is rent paid up to date?
YES
NO
Did you give notice?
YES
NO
Were you asked to leave?
YES
NO
EMPLOYMENT HISTORY
CURRENT EMPLOYER
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor's Name
First Name
Last Name
Occupation
Monthly Gross Salary
Dates of Employment
PREVIOUS EMPLOYER
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor's Name
First Name
Last Name
Occupation
Monthly Gross Salary
Dates of Employment
PRIOR EMPLOYER
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor's Name
First Name
Last Name
Occupation
Monthly Gross Salary
Dates of Employment
CURRENT MONTHLY PAYMENTS
Approximate monthly payment for ALL credit cards combined
Approximate monthly payment for ALL car loans combined
Approximate monthly payment for ALL other debts combined (school loans, child support, etc.)
VEHICLES
PRIMARY CAR
Make
Model
Color
Year
License Plate Number
ADDITIONAL CAR (Include vehicles belonging to Other Occupants)
Make
Model
Color
Year
License Plate Number
ADDITIONAL CAR (Include vehicles belonging to Other Occupants)
Make
Model
Color
Year
License Plate Number
REFERENCES
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
EMERGENCY CONTACT
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
GENERAL INFORMATION
Have you ever been served a late rent notice?
YES
NO
Are you/other occupants smokers?
YES
NO
Have you/other occupants filed for bankruptcy?
YES
NO
If YES to bankruptcy question above, describe.
Have you/other occupants been convicted of a felony?
YES
NO
If YES to felony question above, describe.
Have you/other occupants had problems with current landlord?
YES
NO
If YES to landlord question above, describe.
Have you/other occupants been party to a lawsuit?
If YES to lawsuit question above, describe.
(OPTIONAL) List any any additional verifiable sources of income (not salary) you wish to have considered in this application.
(OPTIONAL) If were to encounter financial difficulties making it impossible to pay your rent, is there a person who would provide you a loan? List that person's name and contact information if you wish that person to be a reference.
A Credit & Criminal Background Check WILL BE DONE. Is there anything negative you would like to comment on before the check is begun?
How long do you expect to reside at this rental property?
When are you available to move in?
How did you hear about this rental property?
Do you know of anyone looking for a rental property? If so, and they end up renting from Firefly Housing, we will pay you a referral fee of $50, provided the referred renters are in good standing at end of 12 months. Kindly, provide their name and phone number.
AGREEMENT & AUTHORIZATION SIGNATURE
AGREEMENT & AUTHORIZATION SIGNATURE
The statements I have made are true and correct to the best of my knowledge. I hereby authorize a credit and/or criminal check to be made, verification of information I provided and communication with any or all names provided in this application. I understand that this is an application for a rental property and is NOT a lease agreement in whole or in part. I further understand that there is a non-refundable fee of $25 per adult occupant listed on the application to cover the cost of processing the application including credit/criminal background check. SPECIAL NOTICE: I understand that a Credit/Criminal Background Check will NOT be done until I and ALL other adult occupants are interviewed by a Firefly Housing Manager and I have submitted a fee of $25 per adult occupant. I further understand I am NOT entitled to a refund of that fee even if I am turned down for the apartment. Any questions regarding a rejected application must be submitted in writing and accompanied by a self-addressed stamped envelope.
Signature
*
Print Applicant's Full Name as it appears in the Signature Box
*
Date of Signature
*
-
Month
-
Day
Year
Date
Submit
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