PERSONAL HISTORY

Name:

Social Insurance Number*:

Date of Birth*: m/day/yr:

Driver’s license number:

License Expiration date:

Home phone #:

E-mail address*:

All additional occupants (name(s) and date(s) of birth):

Present address:

Apt#:

City:

Prov.:

Postal code:

Own/Rent?
OwnRend

Monthly rental: $

Dates:
to

Reason for vacating:

Landlord’s name:

Landlord’s phone number:

Previous address:

Apt#:

City:

Prov.:

Postal code:

Own/Rent?
OwnRend

Monthly rental: $

Dates:
to

Reason for vacating:

Landlord’s name:

Landlord’s phone number:

Auto Make:

Model:

Year:

Colour:

License plate:

Emergency contact name:

Phone #:

Relationship:

*Optional, but filling in these fields will expedite the process.

EMPLOYMENT HISTORY

Present employer:

How long?

Address:

City:

Postal code:

Position:

Gross monthly salary:$

Work phone #: (ext.)

Work e-mail address:

Supervisor’s name:

Supervisor’s phone #: (ext.)

Previous Employer:

How long?

Address:

City:

Postal code:

Position:

Gross monthly salary:$

Work phone #: (ext.)

Work e-mail address:

Supervisor’s name:

Supervisor’s phone #: (ext.)

Other source of income(proof may be required):

REFERENCES

Bank:

Address:

City:

Phone #:

Account #:

Creditors #1:

Address:

Highest amount owed: $

Purpose:

Creditors: #2

Address:

Highest amount owed: $

Purpose:

Personal reference name:

Address:

City:

Phone #:

Relationship:

PERSONAL HISTORY

Have you ever been evicted from tenancy?
YesNo
If yes, explain:

Do you owe any unpaid rent?
YesNo
If so, how much $:

Have you ever filed for bankruptcy?
YesNo

Have you ever violated a lease, rental agreement,
or regulations at a former place of rent?
YesNo

Have you ever been convicted of a crime other than
a motor vehicle violation?
YesNo
If so, what?

Do you own a pet?
YesNo
If yes, what type?

How did you find out about our rental?
NewspaperInternetReferralDrive-byOther