Form Page: RentalForm

Caldwell Housing Rental Application Form

Today's Date

Applicant

First Name

Date of birth

Middle Name

Last Name

Gender

Status

Age

Male

Female

US Citizen

Legal Resident Alien

Co-Applicant

(Must be over 18)

Last Name

Middle Name

Date of birth

First Name

Status

Gender

Age

Male

Female

US Citizen

Legal Resident Alien

How many people under the age of 18 will live with you?

Family Member #1 that will live in house

Age

Gender

First Name

Last Name

Male

Female

Family Member #2 that will live in house

Gender

Last Name

Age

First Name

Male

Female

Family Member #3 that will live in house

Gender

Last Name

Age

First Name

Male

Female

Family Member #4 that will live in house

Gender

Age

Last Name

First Name

Male

Female

Family Member #5 that will live in house

Gender

Age

Last Name

First Name

Male

Female

Family Member #6 that will live in house

Age

Gender

Last Name

First Name

Male

Female

Current Information

City

State

Zip

Address

Current Phone #

Current Cell Phone #

Previous Address #1

Zip

State

City

Address

Landlord Name

Landlord Phone #

Previous Address #2

City

Address

Zip

State

Landlord Name

Landlord Phone #

General Information

Emergency Contact Phone Number

Have you ever been evicted from rental housing?

Yes

Do you have reletives that live here?

Yes

Have you ever lived here before?

If Yes, Who and what unit do they live in?

Total Household income

Please include all sources of income into your household including, but not limited to any government payments or
benefits, any cash assistance, child support, unemployment payments, earning from salaries or employment.

Will this be your Primary Residence?

Yes

Do you authorize the Housing Authority
to conduct criminal background checks
on all household members 18 years of age or older?

Do you authorize the Housing Authority to retrieve
financial information from the Department of Labor
for all household members 18 years of age or older?

Yes

Do you authorize your previous landlord to release to the Housing Authority information regarding your tenancy?

All information provided on this application must be verified with additional information such as I.D. cards, Social Security Cards, pay stubs, tax returns, etc.. If you are eligible to rent from the Caldwell Housing Authority, a representative will call you and ask for the necessary information.