Fillable Printable Connecticut Rental Application Form

Connecticut Rental Application Form

RENTAL APPLICATION - CONNECTICUT DEPARTMENT OF TRANSPORTATION

4/04

Applicant __________________________ Date of Birth ____________________________

Social Sec. # ______________________ Driver's License #________________________

Address _______________________________________________________________________

Home Tel. # ________________________ Work Tel. # ______________________________

Do you rent or own? __________ Amount of mo. rent or mortgage:_________________

Current Landlord/Mortgagee

Name ______________________________________ Tel. #_____________________________

Address________________________________________________________________________

Reason for leaving_____________________________________________________________

How long have you lived at your present address*_______________________________

* If less than 3 years, add sheet with information on prior residence(s)

Current Employment

Employer __________________________________ Tel. #_____________________________

Address________________________________________________________________________

Position _________________ Income _______________ How long employed*___________

* If less than 3 years, add sheet with information on prior employment

Present U.S. Military Status___________________________________________________

Other Income___________________________________________________________________

Total Household Income_________________________________________________________

Total number of vehicles (including Company Cars)______________________________

Type __________________________ Year _____ Tag No.________________ State_______

__________________________ _____ ________________ _______

Credit Cards - Mortgage - Car Loans

Name Account No. Balance Mo.Pymnt.

____________________________ _____________________ _____________ __________

Checking Account: Bank, Address, Account Number and Balance

_______________________________________________________________________________

Savings Account: Bank, Address, Account Number and Balance

_______________________________________________________________________________

Additional Personal References

Name Relationship Telephone

__________________________________ ___________________ _____________________

Have you been bankrupt in the past seven years?________________________________

Are you obligated to pay alimony or child support?_____________________________

Have you ever been evicted or asked to leave a rented unit?____________________

Have you ever not paid rent when due?__________________________________________

Have you ever had any criminal convictions? Yes No If yes, give details.

_______________________________________________________________________________

Parole Officer's Name__________________________________________________________

Parole Officer's Telephone No._________________________________________________

Other Occupants Total number to occupy unit_________________________________

Names, ages and relationship to applicant______________________________________

_______________________________________________________________________________

(All occupants over age 18 should complete a separate application.)

Pets (type, breed and age)_____________________________________________________

Geographic Location Preference 1._______________________2._____________________

Address of State Property______________________________________________________

Rental Offer Per Month_________________________________________________________

Additional Information:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

I/We declare the foregoing information is true and correct, and I/We

hereby authorize the Connecticut Department of Transportation to conduct a

landlord, criminal, and credit check and to verify our employment and

references.

Signature ______________________________________ Date__________________________