Giving Families A Second Chance One Home At A Time!!
Housing Application
Please make sure to also print out a Credit Inquiry Release Form and submit it with the application. We need a form filled out for each person age 18 years or older. Please click the link below to access the form. You may fax all completed Applications to 706-565-0067
Anyone over the age of 18 who plans to be living at the property must fill out a separate application
Which Home are you applying for? ______________________________________
Why do you want this particular home? ____________________________________
When do you want to move in? _______________________________________
How much deposit do you have today? $________________________________
How did you find out about the house? __________________________________
Are you currently on Happ? ____________________________-
Personal Information
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Name: _______________________________________________________
Social Security #: __________________________ Date of Birth: _______________
Driver's License - State & ID#: ______________________________________
Current Address: _____________________________________________________
City / State / Zip: _____________________________________________________
Home Phone: ______________________ Work Phone: ______________________
Cell Phone: ________________________ FAX number: ______________________
Other Adults who will live in the home: _____________________________________
Children Name & Ages:__________________________________________________
How many pets do you own? _________________
Types of pets owned: __________________________________________________
How much do your pets weigh each? ______________________________________ -
Residential History (List the last 3 places you lived)
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Current Landlord's Name: ___________________________________________
Current Landlord's Phone #: ________________________
How long at this address? ______________ Monthly Rent: $________________
Move-in date:__________________ Expected move-out date:_______________
Reason for Moving: ________________________________________________
What Landlord will say about you: _____________________________________
Does current Landlord know your intentions to move? YES or NO (Circle one)
How much notice do you have to give to move? ___________________________ -
Prev. Address: ____________________________________________________
Prior Landlord's Name: ______________________________________________
Prior Landlord's Phone #: __________________________
How long at this address? ______________ Monthly Rent: $________________
Move-in date:______________________ Move-out Date: __________________
Reason for Moving: _________________________________________________
What Landlord will say about you: _____________________________________ -
Prev. Address: ____________________________________________________
Prior Landlord's Name: ______________________________________________
Prior Landlord's Phone #: __________________________
How long at this address? ______________ Monthly Rent: $________________
Move-in date:______________________ Move-out Date: __________________
Reason for Moving: _________________________________________________
What Landlord will say about you: ______________________________________
Have you ever been evicted or asked to leave? YES or NO (Circle one)
When & Why? ______________________________________________________ -
Employment History (List your last 3 consecutive employers)
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Current Occupation: ________________________________________________
Current Employer: _________________________________________________
Current Employer Address:___________________________________________
Supervisor's Name: _____________________________________
Employer Phone #: _______________________
Monthly Take Home Pay: $__________________ Hourly Wage: $____________
How long at this job? _________________________________
Start Work Date: ________________
What will your supervisor say about you? ________________________________ -
Previous Occupation: _______________________________________________
Previous Employer: ________________________________________________
Previous Employer Address:___________________________________________
Supervisor's Name: ____________________________________
Phone #: ___________________
Monthly Take Home Pay: $__________________ Hourly Wage: $____________
How long at this job? _________________________________
Start Work Date: ________________ Last Work Date: ____________________
What will your supervisor say about you? ________________________________ -
Previous Occupation: _______________________________________________
Previous Employer: ________________________________________________
Previous Employer Address:___________________________________________
Supervisor's Name: ____________________________________
Phone #: ___________________
Monthly Take Home Pay: $__________________ Hourly Wage: $____________
How long at this job? ____________________
Start Work Date: ________________ Last Work Date: ____________________
What will your supervisor say about you? ________________________________ -
Financial Background & History
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Other Income You Want Us to Consider Beyond Your Job Income
Alimony Income: $______________ Child Support Income: $_______________
Other: $_______________ Explain:____________________________________ -
Savings Account - What is your average balance? $__________________
Checking Account - What is your average balance? $__________________ -
How much do you owe on your car? $___________________
Monthly Car payment? $________________ Car insurance? $_________________ -
Monthly Alimony You Pay: $_______________ Child Support You Pay: $_____________
Monthly Personal Loans You Pay: $________________
Your Total Monthly Payments on All Financial Obligations (Except rent) $______________
Have you ever filed bankruptcy? YES or NO (Circle one)
When and where did you file bankruptcy? ____________________________________
What were the circumstances and reasons for your bankruptcy?
_____________________________________________________________________
What kind of bankruptcy did you file? Chapter 7 or 13 (Circle one)
What was the amount you discharged? $______________________ -
Have you ever been foreclosured? YES or NO (Circle one)
When and where were you foreclosed? ______________________________________
What were the circumstances and reasons of your foreclosure?
_____________________________________________________________________
What was the amount foreclosed? $__________________________ -
When was the last time you pulled your credit report? _________________
What do you think your average credit score is? _________________ - Vehicle Information (List all vehicles you own.)
Car #1 - Year, Make & Model: ____________________________________________
Car #1 - Plate #: ______________________________- Car #2 - Year, Make & Model: ____________________________________________
Car #2 - Plate #: _____________________________
Boat - Year/Model/Type: ________________________________________________
Motorcycle - Year/Model/Type: ___________________________________________
Camper/RV - Year/Model/Type: __________________________________________
Which vehicles are NOT drivable? ________________________________________
Criminal History
Have you ever been convicted of a Misdemeanor or Felony? YES or NO (Circle one)
They were: (Circle all that apply.)
Sexually-related / Violence-related / Drug-related / Theft-related / Bad checks
Please explain the circumstances/situation. We take special circumstances/situations into consideration.
What were you convicted of?_____________________________________________
____________________________________________________________________
____________________________________________________________________
When and Where did these convictions occur? _______________________________
____________________________________________________________________
____________________________________________________________________
Character References (List character references that are not related to you.)- Nearest Living Relative Name / Phone: _____________________________________
Name / Relation / Phone #: ______________________________________________
Name / Relation / Phone #: ______________________________________________
Name / Relation / Phone #: ______________________________________________
Personal Comments (Additional information and explanations you would like to offer.)
** Tell us why we should consider you for our program and this home:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
I certify that I have answered these questions truthfully, completely, and to the best of my ability. I hereby authorize Landlord and/or his agents to verify the accuracy of all personal information, references, and background listed on this housing application including: Employment History, Landlord History, Credit history, Employment history, Criminal history, Eviction history, Utility Company Usage/Payment history, and Character references.
I authorize Landlord to obtain information from any information reporting service, database, or agency including but not limited to private investigators, credit bureaus, court records, driver license records, and police records. I also authorize current and previous Landlords, employers, and related parties to disclose to Landlord and/or his agents such information as they request.
I understand that any false statements made herein this application is immediate grounds for forfeiture of any deposits or monies paid in already. I also understand that the discovery of false or incomplete statements may result in the immediate disqualification of this application, tenancy, termination of lease, and could result in eviction action. I hereby release the Landlord and/or his agents from any and all liability or damages of any kind to me, my heirs, family, or associates because of compliance with this information verification process.
__________________________________________________________________________
Housing Applicant's Signature & Date
We prefer that you FAX the application to (706) 565-0067 for consideration. We ask that you please call us before faxing at 706-442-3610 or 706-888-5052
Visit your local Office Depot, Staples, or OfficeMax if you do not have access to your own FAX machine.