Today's Date:	Desired Date of Occupancy:

Applicant's Name:

Social Security #:

Date of Birth:

Education (years):

Description of Pets:

Marital Status: Choose One Single Married Separated Divorced

How Long?:

# of Bedrooms Needed:

Co-Applicant's Name:

Social Security #:

How did you hear about our property?:

Location of “For Rent” Sign: Choose Address 418-426 Mount Prospect Ave, Newark 212 Highland Ave, Newark 409 Summer Ave, Newark 583 Mt. Prospect Ave, Newark 131 Grafton Ave, Newark 443 Delavan Ave, Newark 497-501 North 12th St, Newark 383 Clifton Ave, Newark 480 Clifton Ave, Newark 484 Clifton Ave, Newark 44 Heller Parkway, Newark 223 Prospect Ave, East Orange 180-188 Glenwood Avenue, East Orange

Referred By:

Occupant Name	Relationship to Head of Household	Age	Sex
1.
2.
3.
4.
5.
6.

RESIDENCE HISTORY Present Street Address:	Phone #:

Town:	Zip Code:	How Long:	Rent $:

Reason for Leaving:

Present Landlord:

Address:

Phone #:

Previous Address (If less than 3 yrs):

How Long:

Have you ever been evicted from an apartment? Choose One Yes No

INCOME Employed By:

Phone #:

How Long:

Address:

Supervisor:

>

Current Position:

Income $:

Paid? Choose One Weekly Bi-Weekly Monthly

Previous Employment:

Address:

Phone #:

How Long:

Reason for Leaving:

Co-Applicant Employment:	Phone #:	How Long:

Address:

Supervisor:

Current Position:

Income $:

Paid? Choose One Weekly Bi-Weekly Monthly

Do you have any other income?

Monthly $:

Monthly Child Support $:

Child Support Pay or Receive? Choose One Pay Monthly Receive Monthly

If not employed, show source of income (monthly): Welfare $:	Social Security $:

Pension $:

Disability $:

Unemployment $:

How long have you been on Welfare, Social Security, Disability, etc?

Do you have a Section 8 Certificate? Choose One Yes No

# of Bedrooms: Choose One 0 1 2 3

Name of Agency:

Name of Caseworker:

Do you own a car or truck? Choose One Yes No

Do you require off-street parking? Choose One Yes No

Vehicle Year	Make	Model	Color	License Plate #
1.
2.

Personal Reference Name:	Address:	Phone #:
Personal Reference Name:	Address:	Phone #:

I understand that this is a preliminary application and gives no lease or rental rights, and in no way guarantees me an apartment. I certify that the facts given in this application are true and complete, and I understand that if I have misrepresented or omitted facts it is grounds for termination of my lease if I am accepted. Choose One Accept Decline

PERMISSION TO CHECK CREDIT I hereby grant Calello Agency the right to process this credit application for the purpose of obtaining a rental lease. In compliance with the FAIR CREDIT REPORTING ACT, this notice is to inform you that the processing of the application includes, but is not limited to, making inquiries deemed necessary to verify the accuracy of the information herein, including running a credit report with Experian Information Solutions, Inc., and criminal background check from appropriate law enforcement agencies. The undersigned agrees that this application shall remain the property of Calello Agency regardless if the rental lease is granted. Choose One Accept Decline

Applicant’s Signature:	Date:
Co-Applicant’s Signature:	Date: