Rental Application - Usda/hud Properties Only Page 4

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USDA/HUD HOUSING APPLICATION 
 
 
Previous Housing:   Own______      Rent ______      Other ______    Monthly Amount $_________ 
 
 
 
Previous Address: _______________________________________________________________________ 
 
                                     Street                                                          City                       State                     Zip Code 
 
 
 
Landlord’s Name: ________________________________________________________________________ 
 
 
 
Landlord’s Address: ______________________________________________________________________ 
 
                                     Street                                                          City                        State                    Zip Code 
 
 
 
Landlord’s Telephone: ________________________  Date of Residency:____________________________
      
 
                                                                                                                                              (Mo./Yr.)         to            (Mo./Yr.) 
 
If related to Landlord, state relationship: _________________________ 
 
 
EMPLOYMENT INFORMATION 
 
 
 
Present Employer:_______________________________   Telephone # :__________________________ 
 
 
 
Employer Address:  _____________________________________________________________________ 
 
                                     Street                                  City                               State              Zip Code 
 
 
Occupation : ________________________  Dates of Employment: _______________________________ 
 
                                                                                                                          
(Mo./Yr.)            to              (Mo./Yr.) 
 
 
 
Salary:  $______ per hour          _______  Hours per     week      month      other  _________________ 
 
 
 
Second Employer, or 
 
Previous Employer:  _____________________   Telephone #:  ____________________________ 
 
 
 
Employer Address:  _____________________________________________________________________ 
 
                                    Street                                           City                            State              Zip Code 
 
 
Occupation:  ________________________    Dates of Employment: ______________________________ 
 
                                                                                                                          
(Mo./Yr.)         to            (Mo./Yr.) 
 
 
 
Salary:  $______ per hour          _______  Hours per     week      month      other  _________________ 
 
 
 
 
 
Spouse Employer: _________________________              Telephone Number:________________________  
 
 
 
Employer Address:  ______________________________________________________________________ 
 
                                    Street                                           City                            State              Zip Code 
 
 
Occupation:  ________________________    Dates of Employment: _______________________________ 
 
                                                                                                                              
(Mo./Yr.)         to            (Mo./Yr.) 
 
 
 
Salary:  $______ per hour          _______  Hours per     week      month      other  __________________ 
 
 
 
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