Baltimore Hotel Application - Healthy Housing Foundation

BALTIMORE HOTEL HOUSING APPLICATION

***READ BEFORE BEGINNING***

This application takes 15-30 minutes to complete. You cannot save your progress, so make sure you have enough time to finish before you begin. You can also print out an application from out website and mail it in.

TO COMPLETE THIS APPLICATION YOU WILL NEED:

Your Social Security number.
A photo or scan of your driver's license or state ID.
A photo or scan of your proof of income (examples: pay stub, benefits letter).
Contact information for your case worker, current landlord, current employer (if you have these) and for two character references (required).
Vehicle information (make/model/license plate) for any vehicle you own or use regularly.

Your Name*

Social Security Number*

Driver's Licence or State ID Number

Your Phone Number

Your Email Address

ATTACH AN IMAGE OF YOUR GOVERNMENT-ISSUED PHOTO ID (REQUIRED)*

ATTACH AN IMAGE OR SCAN OF YOUR INCOME VERIFICATION FOR ALL INCOME SOURCES, SUCH AS: Pay Stub, SSI Check Stub, GA Check Stub, etc. (REQUIRED)*

Do you currently have a Case Manager? *

Yes

Case Manager Name

Case Manager Email

Case Manager Phone

Case Manager Agency/Organization

Date of Birth*

Your Current Address*

Street Address or Cross Streets City State / Province Postal / Zip Code Country

Your Previous Address

Street Address City State / Province / Region Postal / Zip Code Country

Current Landlord Name

Current Landlord Phone

Monthly rent amount you are currently paying

USD

Do you have a car or other vehicle?

Yes (If yes, please fill out vehicle info below)

Vehicle Licence Plate

Vehicle State Registered

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Color

Do you have pets? *

If you have pets, can you provide a Certificate of Good Health/Proof of Vaccination/Service Animal Certification for all your animals?*

Yes - I can provide this for my animals.

No - I cannot provide this for my animals.

I do not have animals.

Have you ever been evicted or had an unlawful detainer filed against you? *

Yes

Do you have any credit problems?*

Yes

Have you ever been convicted of drug trafficking? (Examples: Selling, distributing, importing/exporting controlled substances?) *

Yes

Have you ever been convicted of a felony? *

Yes - Please indicate the YEAR and STATE you were convinced (example: 1987, CA)

Have you ever been convicted for a crime against persons? If yes, check all below that apply. *

No - I have not ever been convicted of a crime against persons

Yes - Robbery/Aggravated Robbery

Yes - Manslaughter/Murder/Attempted Murder

Yes - Sexual Assault/Rape

Yes - Battery/Assault/Aggravated Assault

Yes - Other (Please specify)

You may explain any "YES" answers for the previous five questions. (If you answered "YES" to any convictions, please list the year and state.)

OPTIONAL (does not impact your application): Would you consider being interviewed or speaking publicly about your experience with the Healthy Housing Foundation?

Yes

Maybe

Applicant represents that statements made are true, correct and hereby authorizes verification of references to include but not limited to credit checks, unlawful detainer checks & credit checks and agrees to furnish additional credit references on request. I authorize verification of the information contained herein solely for the purpose of establishing my qualifications as a tenant. I release anyone verifying such information or providing information, from liability. I understand that incomplete or incorrect information provided in the application, may cause a delay in processing and can result in denial of tenancy. I understand that even if I am granted a residence based on my initial credit check, that a fuller credit check will still be conducted up to 30 days after my initial application. I understand that if this fuller credit check reveals falsified information in my application that this is grounds for eviction and I may be denied further housing with the Healthy Housing Foundation. *

Check here to accept these terms

TYPE YOUR FULL, LEGAL NAME IN THE BOX BELOW TO ELECTRONICALLY SIGN THIS FORM. (REQUIRED) *

Today's Date*

List the full legal names and ages of all people who will live in the unit (including yourself). *