Rental Application - Mississippi Alternative Housing Program
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4RENTAL APPLICATION
(NOTICE: CO-APPLICANT MUST FILL OUT A SEPARATE APPLICATION)
Non- Refundable Application Fee of,.::t::$ __
must be included with this Application.
PLEASE TELL US ABOUT YOURSELF:
Full Name
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Social Security Number ___________________ Date of Birth _ _ _ _ _
Spouse'sFullN~e
__________________________________________ __
Spouse's Social Security Number ______________ Date of Birth _ _ _ _ _
Phone
Email
- - - - - - - - - - - - - - - - - - - - - - - - - - -
RENTAL HISTORY (For the past 2 years, beginning with most current)
Current address
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owned- Rented- Other How Long? From: ___________ To: __________ _
Landlord/1vlanager Name ___________________ Phone ______________ _
Previous Address
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owned- Rented- Other Ho\v Long? From: _ _ _ _ _ To: ____________ _
Landlord/Manager
N~e
Phone ______________ _
EMPLOYMENT INFORMATION
Employment Status, please Circle one:
Employed Full-Time, Part-time, Student, Retired, Unemployed, Other
Cunent Employer:
Position
1vlonthly Salary$ _ _ _ _ _ _ _ Annual Salary $ _ _ _ _ _ _ _ _ _ _
Supervisor's
N~e
Telephone Number
( )
If employed by above less than 6 months, give
n~e,
address, and telephone # of previous
employer or school
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Parent category: Business