Forms

New Housing Application Form

Date of application*
MM slash DD slash YYYY
Applicant Information
First name*
Last name*
Date of birth*
MM slash DD slash YYYY
Mailing address*
City*
Province*
Postal code*
Primary phone*
Email*
Marital status*
How long have you lived in Fort Chipewyan?*
Spouse Information
First name*
Last name*
Currently employed?*
- Yes
- No
If yes, please of occupation
Family/Dependent Information
Number of children*
Children’s names
Previous Residence Information
Street address*
City*
Province*
Owner/landlord name*
Owner/landlord phone number*
How long did you reside there?*
Reason for leaving*
Employment Income Information
Employer*
Employer phone number*
Length of employment*
If not employed, please provide details on current source of income.
Bank Information
Bank name*
Branch number*
Phone number*
Address*
City*
Province*
Postal code*
Checking account number
Saving account number
Personal References
Please provide at least two personal and two professional references who can comment on you as an individual. These cannot include family members.
#1 Personal reference name and phone number*
#2 Personal reference name and phone number*
#1 Professional reference name and phone number*
#2 Professional reference name and phone number*
Additional Information
Have you ever filed for bankruptcy?*
- Yes
- No
If yes, when?
Have you ever been served an eviction notice or been asked to vacate a property you were renting?*
- Yes
- No
If yes, please explain?
Have you willfully or intentionally refused to pay rent when due?*
- Yes
- No
If yes, please explain?
Authorization to Release Information
Applicant hereby authorizes verification of any and all information set forth on this application, including releases on information by any bank, savings and loan, employer (present or former) landlord and/or other lender. All such information hereon, and released as authorized above, will be kept confidential. APPLICANT REPRESENTS THAT THE INFORMATION SET FORTH ON THIS APPLICATION IS TRUE AND COMPLETE. Material representation on this application will constitute default under the Lease or Rental Agreement between parties.
*
- I agree
First and last name of applicant*

Forms

New Housing Application Form

Applicant Information

Spouse Information

Family/Dependent Information

Previous Residence Information

Employment Income Information

Bank Information

Personal References

Additional Information

Authorization to Release Information