Move In Details What unit are you interested in? (required) 1 Bedroom 1 Bath2 Bedroom 2 Bath3 Bedroom 2 Bath When would you like to move in? A Bit About You First Name (required) Your Email (required) Other Phone Co-Applicants Name Other Occupant(s) 1 Full Name Other Occupant(s) 2 Full Name Other Occupant(s) 3 Full Name Have you any pets? If so, how many? Last Name (required) Home Phone Date of Birth Co-Applicants Birthday Relationship to Occupant 1: Relationship to Occupant 1: Relationship to Occupant 1: Please Provide Your Residential History Current Full Address with zip/postal code (required) What month/year did you move in? Reasons for leaving? Rent Amount $ per month? Full Name of Owner/Agent Phone of Owner/Agent Previous Address (if within the last 3 years) Reasons for leaving? Rent Amount $ per month? Full Name of Owner/Agent Phone of Owner/Agent Please Describe Your Credit History Have you declared bankruptcy in the past seven (7) years? NoYes Have you ever been evicted from a rental residence? NoYesPlease Provide Your Employment Information Your Employment Status (Full time, Part time, etc) Dates Employed Supervisors Name Monthly Salary Employer Position Held/Occupation Supervisors Phone Number If employed by your last position for less than 12 months, give name and phone of previous employer If you have other sources of income that you would like us to consider, please list income, source, and person who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application. Spouse/Other Income Source/Contacts Name Spouse Employer Amount per Month Dates Employed Employer Phone Number Driver's License Information Driver's License Number 1 Driver's License Number 2 Make / Model of Vehicle 1 and Year Tag #/State Vehicle 1 State of Driver's License Number 1 State of Driver's License Number 2 Make / Model of Vehicle 2 and Year Tag #/State Vehicle 2 Personal Reference of Emergency Contact Emergency Contacts Name Emergency Contacts Phone Emergency Contacts Address Emergency Contacts Relationship Personal References Name of Reference 1 Relationship 1 Phone Number 1 Address 1 Name of Reference 3 Phone Number 3 Name of Reference 2 Relationship 2 Phone Number 2 Address 2 Relationship 3 Address 3 I acknowledge that the above statements are true and complete and further authorize verification of such statements including release of any police records if needed, now and for the duration of my tenancy. I verify that I am of legal age (18 years or older). I authorize Park Crossing Apartments to conduct a criminal background check, a credit check including the acquisition of a credit report, a sex offender registry check, a check of landlord/tenant databases, a terrorist/wanted fugitive check, a current and previous landlord check, and a check of my references if requested. I further authorize Park Crossing Apartments to share information contained in my application and background reports as well as any information regarding my tenancy with the agencies or persons listed above, including my Landlord. Yes Δ