Property Management, Inc. RENTAL APPLICATION Marketing info: How did you hear about the community?
|
|
- Nigel Evans
- 5 years ago
- Views:
Transcription
1 EQUAL HOUSING O P P O R T U N I T Y Justus Property Management, Inc. RENTAL APPLICATION Marketing info: How did you hear about the community? Please include an $16.00 fee for each adult household member. (Sorry, no cash accepted) Thank you. Date Paid Please Print when completing this application IF CO-APPLICANTS ARE APPLYING FOR RESIDENCY, AND HAVE NOT LIVED TOGETHER AT THE SAME ADDRESS FOR AT LEAST 2 YEARS, SEPARATE APPLICATIONS MUST BE COMPLETED. Date of Application Type and Size of Residence (Office use only) Date Received Time Received Received by: (Manager s signature) Residential Community: Culver s Hill Desired Move-In Date APPLICANT S FULL NAME Telephone # Alternate phone or Cell# RESIDENT HISTORY ( FULL 2 YEAR HISTORY REQUIRED) Current Address (including zip code) Current County How long have you lived here? Landlord's Name Landlord's Phone Landlord's Address Amount of rent paid? Past due? Reason for Moving Previous Address (including zip code) Previous County How long did you live there? Landlord's Name Landlord's Phone Landlord's Address Amount of rent paid? Past due? Reason for Moving VERIFICATION OF LANDLORDS (for office use only) Contact date Time Contact date Time Spoke to Spoke to Position/ Relationship of contact Position/ Relationship of contact Contact Phone # Contact Phone # Comments Comments Rerent? Yes No (circle one) Rerent? Yes No (circle one) Interviewer s signature Interviewer s signature 728DE application
2 PERSONAL REFERENCES Name Address Day Phone Evening Phone Relationship Name Address Day Phone Evening Phone Relationship HOUSEHOLD COMPOSITION NAMES OF HOUSEHOLD MEMBERS RELATIONSHIP SOCIAL OF STUDENT? TO OCCUPY THIS HOME TO HEAD OF SECURITY BIRTH YES or NO HOUSEHOLD NUMBER Due to the disability of a household member, are you requesting an accessible home or would any member benefit from the features in an accessible home? Yes No (Documentation may be required) ANNUAL INCOME 728DE application Gross Wages Social Security TANF, AFDC, Other and Salaries Pensions, SSI, etc. Welfare (Support, Regular gifts) Head of Household $ $ $ $ Co-Head or Spouse $ $ $ $ Co-Head 2(additional) $ $ $ $ Co-Head 3(additional) $ $ $ $ Please provide any additional information necessary for contact regarding any other source of Household income that may not be listed above:
3 FAMIY ASSETS & BANKING REFERENCES 1.Checking account # Bank Name/ Location 2.Checking account # Bank Name/ Location 1.Savings account # Bank Name/ Location 2.Savings account # Bank Name/ Location CD$ Stocks & Bonds$ Real Estate$ Money Mkt$ IRA$ Other funds$ (please specify) List contact information on other accounts, use back side of application if necessary ASSET DISPOSAL, CIVIL HISTORY, CRIMINAL BACKGROUND (all members over 18) (HOH) Head of Household Status: (check one) Married Divorced Single (never married) (CoH) Co-Head Status: (check one) Married Divorced Single (never married) (Co2) Co-Head 2 Status: (check one) Married Divorced Single (never married) (Co3) Co-Head 3 Status: (check one) Married Divorced Single (never married) GENERAL QUESTIONS Is an Adult family member able to secure utilities in their name prior to occupancy? Answer to each utility, most will require deposits---- Electric Service Yes No Sewer Yes No NIPSCO (Natural Gas) Yes No Water Yes No Do you have a pet? Yes No Dog Cat Description Weight lbs. 728DE application
4 Please ask for the complete packet regarding pets: policy, information sheet and agreement. In considering this application from you, Management will rely heavily on the information that you have supplied. It is most important that the information be accurate and complete. By signing this application, you represent and warrant the accuracy of the information and you authorize Management to verify any references or information that has been supplied to the community management. Please be advised that persons with disabilities have the right to request reasonable accommodations to participate in the application process. ********************************************************************************************* I hereby certify that the home being applied for will serve as my permanent residence and that I will not maintain a separate subsidized or other rental premises in a different location. I attest that no applicant member of my household, as listed on page 2, is subject to a lifetime registration requirement under any State Sex Offender registration program. ************************************************************* THERE SHALL BE NO DISCRIMINATION BECAUSE OF RACE, COLOR, AGE, MARITAL OR FAMILIAL STATUS, RELIGION, SEX, NATIONAL ORIGIN, HANDICAP, DISABILITY, SEXUAL ORIENTATION, GENDER IDENTITY, OR SOCIOECONOMIC CLASS. (6/12) I ATTEST THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE. I have fully disclosed all relevant information including all household income and assets. I understand that there is an $18.00 per adult applicant non-refundable processing fee, which I am also responsible for paying at the time I submit this application. By execution of this application, I hereby authorize Justus Property Management, Inc. to verify all information provided on this application and to contact previous landlords and make such investigations into my utility credit history, criminal background, as applicable, and as they may deem appropriate. I understand that such investigations typically include (but are not limited to) verification of income, employment and salary, rental history, criminal history, and utility credit. I also authorize Justus Property Management, Inc. to release such information to appropriate Federal, State or local agencies. I agree that in addition to execution of a Lease Agreement that I will execute a tenant certification attesting to the information contained herein, which certification will be made under the penalty of perjury. APPLICANT (Head of Household) Signature APPLICANT (Co-Applicant) Signature APPLICANT (Co-Applicant) Signature 2 APPLICANT (Co-Applicant) Signature 3 728DE application
5 One Strike Rule & Sex Offender Registry Policy Community In accordance with Federal Regulations mandating the implementation of more stringent criminal background screening of all applicants for housing assistance, HUD developed the One Strike Rule. In response to this rule, this Community has chosen to conduct criminal history checks on all applicants (18 years of age and older) giving special attention to those applicants with: 1) A history of arrest and/or conviction for criminal activity or eviction involving drug related activity and crimes of physical violence to persons or property, or other criminal acts which adversely affect the health, safety, or welfare of other residents, including but not limited to: a) Possession of drugs b) distribution of drugs c) gang-related activity d) rape e) child molestation f) murder/attempted murder 2) A pattern of continuous or repeated arrest and/or conviction for the same activity, including but not limited to: a) Public intoxication b) disturbance c) resident arrest d) public indecency 3) Any Felony conviction within the last 5 years from the date of application will result in denial. Any open or pending felony charges will result in denial. A single felony conviction, EXCLUDING violent or sex crimes, over 5 years old from the date of application will not automatically result in denial. 4) In addition, we prohibit lifetime registered sex offenders from admission to our subsidized housing therefore: Sex Offender Registry screening of all adult members of the household will be conducted prior to approval for occupancy Applicants: I have read and understand the One Strike Rule Admissions statement. I understand that the apartment community listed above will conduct a criminal history check on all members of the household 18 years of age and older. In addition they will conduct a Sex Offender Registry Check on all adult members of the household as well. I consent to the release of my personal history allowing all relevant criminal or sex offender information to be released for this purpose. I further understand that my application will be denied on the basis of an unfavorable criminal or sex offender history regarding myself or another family member. Household member (18 year of age or older) Date Maintain original in Resident s file. 901 RD One Strike/ Sex Offender Policy 5-12
6 NTN - Indiana Phone Fax Justus Property Management Order Form Culver Hill - IN 4326 Fax This order is for: Applicant Screening Employment Screening Applicant Personal Information (Print legibly) Name: Last First Middle Address: City: ST: Zip: SSN: DOB: / / To be filled in by Justus Employees: Nationwide Criminal (includes Nationwide Sex Offender) LaGrange County Criminal County Criminal Please check box(es) if applicant previously lived in these states: Colorado N Carolina Massachusetts New York. Designate county for state checked above: County Criminal County Criminal Nationwide Sex Offender I certify that the above information is correct and complete and hereby authorize a criminal background check for resident screening or employment screening purposes only. I understand that if I am applying for employment and am hired, I will be an employee of Justus Property Management Inc. Signature of Applicant: Date Signed: Fax order to: or
PRE-APPLICATION FOR HOUSING
PRE-APPLICATION FOR HOUSING Royal Gardenes C/O Rental Office Concord, NH 03301 Phone: (603) 224-9732 FOR OFFICE USE ONLY / Time Application Received: / / : AM / PM Received by (Initials): PLEASE NOTE ANY
More informationINSTRUCTIONS FOR COMPLETING THE APPLICATION FOR ASSISTED HOUSING:
INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR ASSISTED HOUSING: Thank you for your interest in obtaining housing at one of our properties. The following instructions, if followed properly, will ensure
More informationRESIDENT SELECTION CRITERIA
General: RESIDENT SELECTION CRITERIA If the applicant(s) do(es) not meet any of the following selection criteria, or if the applicant(s) provide(s) inaccurate or incomplete information, the application
More informationLutheran Senior Services of Southern Chester County (PA), Inc. Luther House II, Inc. Luther House III, Inc. Luther House IV, Inc.
Lutheran Senior Services of Southern Chester County (PA), Inc. Luther House II, Inc. Luther House III, Inc. Luther House IV, Inc. Thank you for your interest in Luther House. There are a total of 256 apartments
More informationPreliminary Application
Preliminary Application Date: HOUSEHOLD COMPOSITION AND CHARACTERISTICS: List the Head of Household and all other people who will be living in the unit. You must indicate one of the HUD approved relationship
More informationPLACE A NEXT TO EACH LOCATION YOU ARE APPLYING FOR
Application for Occupancy 491 E Center Street, Juneau, WI 53039 Phone: 920-386-2866 * TTY: 1-800-947-3529 * Fax: 920-386-2725 Website: www.dodgehousing.org * Email: info@dodgehousing.org PLACE A NEXT TO
More informationFOR OFFICE USE ONLY: Date Received: / / Time Received: am/pm Received By: PASCO COUNTY HOUSING AUTHORITY LAKE GEORGE MANOR
FOR OFFICE USE ONLY: Received: / / Time Received: am/pm Received By: PASCO COUNTY HOUSING AUTHORITY 15219 DAVIS LOOP DADE CITY, FLORIDA 33523 (352) 567-0165 PLEASE READ CAREFULLY AND RETAIN THIS PAGE FOR
More informationTENANT SELECTION PLAN Providence House 312 N 4 th Street, Yakima WA Phone: TRS/TTY: 711
TENANT SELECTION PLAN Providence House 312 N 4 th Street, Yakima WA 98901 Phone: 509-452-5017 TRS/TTY: 711 ELIGIBILITY REQUIREMENTS Households applying for residency must meet the following criteria: The
More informationCity of Ames CDBG Renter Affordability Program Deposit and/or First Month s Rent Assistance CHECKLIST FOR APPLICATION SUBMITTAL
City of Ames CDBG Renter Affordability Program Deposit and/or First Month s Rent Assistance The purpose of this program is to assist low income households with up to $1,200.00 towards their rental deposit
More informationJUDSON TERRACE HOMES 3000 AUGUSTA STREET, SAN LUIS OBISPO, CA TELEPHONE (805) TDD EXT. 478
JUDSON TERRACE HOMES 3000 AUGUSTA STREET, SAN LUIS OBISPO, CA 93401 TELEPHONE (805) 544-1600 TDD 800-545-1833 EXT. 478 JTH-ADMINISTRATOR@ABHOW.COM RESIDENT SELECTION PLAN Judson Terrace Homes is a 75 unit
More informationRESIDENT SELECTION PLAN
VINEYARD VILLAGE 3700 PACIFIC AVE, LIVERMORE, CA 94550 TELEPHONE (925) 443-9270 TDD (800) 545-1833 EXT. 478 VINEYARD-ADMINISTRATOR@ABHOW.COM WWW. VINEYARDVILLAGELIVERMORE.COM RESIDENT SELECTION PLAN Vineyard
More informationComanche Nation Housing Authority Service with Pride
Comanche Nation Housing Authority Service with Pride 402 S.E. F Ave, Lawton, Oklahoma 73502 Telephone 580.357.4956 Fax 580.280.4714 APPLICATION INSTRUCTIONS FOR THE TRANSITIONAL HOUSING PROGRAM TO QUALIFY
More informationPreliminary Application for Housing. Please Check One Facility Per Application! DGN I, Inc. DGN II, Inc. DGN III, Inc. Head of Household (HOH):
Douglas Gardens Senior Housing, Inc. Management Agent 705 SW 88th Avenue Pembroke Pines, Florida 33025 TTY/VCO 800-955-8771 / Phone 954-704-3464 / Fax 954-438-1050 Preliminary Application for Housing Please
More informationApplicant s Name (print legibly): KIHA Use Only: Date & time signed application received by KIHA: Date: Time: By:
Applicant s Name (print legibly): KIHA Use Only: Date & time signed application received by KIHA: Date: Time: By: NAHASDA ASSISTED RENT & RENTAL ASSISTANCE APPLICATION PACKET INSTRUCTIONS: COMPLETE & RETURN
More informationTENANT SELECTION PLAN
TENANT SELECTION PLAN Providence House 540 23 rd Street, Oakland CA 94612-1718 Phone: (510) 444-0839 TRS/TTY: 711 Providence House is comprised of 1-bedroom and 2-bedroom apartments. All apartments are
More informationApplicant s Name (print legibly): KIHA Use Only: Date & time signed application received by KIHA: Date: Time: By:
Applicant s Name (print legibly): KIHA Use Only: Date & time signed application received by KIHA: Date: Time: By: LOW RENT & RENTAL ASSISTANCE APPLICATION PACKET INSTRUCTIONS: COMPLETE & RETURN THIS ENTIRE
More informationAPPLICATION FOR SECTION 8 RENT ASSISTANCE AND PUBLIC HOUSING
NORTHWEST MINNESOTA MULTI-COUNTY HRA PO Box 128 205 Garfield Avenue Mentor, MN 56736-0128 Phone: 218-637-2431 www.nwmnhra.org APPLICATION FOR SECTION 8 RENT ASSISTANCE AND PUBLIC HOUSING INSTRUCTIONS:
More informationName Male/Female Soc. Sec. # Birthdate Relationship. Name Male/Female Soc. Sec. # Birthdate Relationship
Application for Affordable Housing Managed by Catholic Housing Communities; 12 E. 5 th Ave; Spokane, WA 99202 Phone: (509) 358-4250 Fax: (509) 358-4259 APPLICATION TO RENT Size of Unit Required: (circle
More informationPART III: DENIAL OF ADMISSION
ELIGIBILITY Spokane Housing Authority (SHA) is responsible for ensuring that every individual and family admitted to the public housing program meets all program eligibility requirements. This includes
More informationPRE-APPLICATION FOR HCV ASSISTANCE
Please complete and return to: Housing Authority of the City of Lumberton Attn: Housing Choice Voucher 613 King Street Lumberton, NC 28358 PRE-APPLICATION FOR HCV ASSISTANCE Head of Household Phone Current
More informationWE CAN NOT/WILL NOT CONTACT YOU!
It is YOUR responsibility to contact our office 3 days after applying to see if you have been approved for a Public Defender. WE CAN NOT/WILL NOT CONTACT YOU!..................... If you are applying on
More informationLast Name First Middle
For Office Use Only 03/15 Appointment @ Hearing @ Withdrawn For 4817 South Catherine Street Eligible Suite 101 Ineligible For Plattsburgh NY 12901 Phone: 518-561-0720 Fax: 518-561-1769 Date. BR Size www.phaplattsburgh.com
More informationEmilie House 5520 NE Glisan, Portland OR Phone: (503) Fax: (503) TTY Relay: 711
Emilie House 5520 NE Glisan, Portland OR 97213-3170 Phone: (503) 236-9779 Fax: (503) 239-1867 TTY Relay: 711 TENANT SELECTION PLAN Eligibility People applying for residency at Emilie House must: Be 62
More informationIncome Guidelines Family Size MINIMUM Family Size MINIMUM
OVER INCOME LEASE TO OWN PROGRAM Income Guidelines Family Size MINIMUM Family Size MINIMUM 1 $40,264 5 $62,122 2 $46,016 6 $66,723 3 $51,768 7 $71,325 4 $57,520 8 $75,926 Applicants MUST meet the above
More informationAPPLICATION FOR COURT-APPOINTED ATTORNEY
APPLICATION FOR COURT-APPOINTED ATTORNEY This section to be filled out by Court Personnel CAUSE # The State of Texas vs. JP #: Bond: In the Brazoria County, Texas Offense Level of Offense Court All information
More informationGREENE METROPOLITAN HOUSING AUTHORITY
GREENE METROPOLITAN HOUSING AUTHORITY NOTICE TO ALL APPLICANTS It is the policy of (GMHA) to comply fully with all Federal, State and Local nondiscrimination laws and with the rules and regulations governing
More informationRESIDENT SELECTION CRITERIA
RESIDENT SELECTION CRITERIA A rental application, credit, rental references and criminal report must be processed on all prospective residents 18 years of age or older. Applications will not be approved
More information3501 West State Street, Boise Idaho 83703
APPLICATIONS MAY BE HELD FOR UP TO 3 MONTHS. APPLICANTS ARE ENCOURAGED TO REAPPLY. APPLICANT INFORMATION PAGE 1. First Name: SSN: Phone number: Last Name: Date of Birth: Cell Phone: Drivers License No:
More informationIncome Requirements Applicant MUST meet income limits
Absentee Shawnee Housing Authority P.O. Box 425 107 N. Kimberly Shawnee, Oklahoma 74802-0425 Phone (405) 273-1050 Fax (405) 275-0678 Income Requirements Applicant MUST meet income limits LEASE WITH OPTION
More informationLORAIN METROPOLITAN HOUSING AUTHORITY. APPLICANT SCREENING PROCESS Revised July 2017
LORAIN METROPOLITAN HOUSING AUTHORITY APPLICANT SCREENING PROCESS Revised July 2017 After verification of all pertinent data required determining eligibility, applicants shall be notified of their eligibility/ineligibility.
More informationThe management team at Kensington Village Apartments looks forward to your residency. In order to move in we will require:
Dear Prospective Resident, The management team at Kensington Village Apartments looks forward to your residency. In order to move in we will require: 1. A completed application from each applicant 18 years
More informationAPPLICANT CHECKLIST II.
APPLICANT CHECKLIST SECTIONS I. and II. are required with the initial application submission. All questions must be answered, even if the answer is No or N/A. Questions or areas left blank may require
More informationEMPLOYMENT APPLICATION
EMPLOYMENT APPLICATION Eyerly Ball CMHS is an Equal Opportunity Employer. Federal & State law prohibit discrimination on the basis of race, color, religion, gender identity, age, disability, sexual orientation,
More informationPETITION FOR CONTEMPT OF A CUSTODY ORDER
PETITION FOR CONTEMPT OF A CUSTODY ORDER 1. Forms FORMS, FILING AND SERVICE PROCEDURES Attached is a packet of all forms necessary to file a Petition for Contempt of an existing Custody Order in the Monroe
More informationA PA APPLICATION FOR HOUSING DEVELOPMENT MINISTRY OF AGRICULTURE, LANDS, HOUSING & ENVIRONMENT
MINISTRY OF AGRICULTURE, LANDS, HOUSING & ENVIRONMENT Central Housing And Planning Authority APPLICATION FOR HOUSING DEVELOPMENT For Office Use Only Date Received: Time Received: CHAPA Client # Note: Application
More informationPRE-APPLICATION FOR HCV ASSISTANCE
Please complete and return to: Housing Authority of the City of Lumberton Attn: Housing Choice Voucher PO Drawer 709 Lumberton, NC 28359 PRE-APPLICATION FOR HCV ASSISTANCE _ Head of Household Phone Physical
More informationKNICKERBOCKER APARTMENTS TENANT SELECTION PROCEDURE
KNICKERBOCKER APARTMENTS TENANT SELECTION PROCEDURE POSITION Knickerbocker Apartments, sponsored by Bay Inter-Faith Housing, Inc. was approved by the U. S. Department of Housing and Urban Development (HUD)
More informationPULLMAN ARTSPACE LOFTS RESIDENT SELECTION PLAN S. Langley Chicago, IL Owners: Pullman Artspace Lofts LP Managng Agent: Ludwig and Company
PULLMAN ARTSPACE LOFTS RESIDENT SELECTION PLAN 11137 S. Langley Chicago, IL 60628 Owners: Pullman Artspace Lofts LP Managng Agent: Ludwig and Company I. INTRODUCTION This Resident Selection Plan outlines
More informationCHANGE IN FAMILY COMPOSITION ADD/CHANGE/REMOVE LIVE IN CAREGIVER
Section 8 Office 700 Andover Park W Seattle, WA 98188-3326 www.kcha.org Phone 206-214-1300 Fax 206-243-5927 OFFICE USE ONLY FORM #: 815 HH ID #: UNIT #: EFFECTIVE DATE: CHANGE IN FAMILY COMPOSITION ADD/CHANGE/REMOVE
More informationShared Housing Services
SHS Shared Housing Services Shared Housing Services provides affordable, alternative housing solutions to continue and enhance the independence and self-sufficiency of individuals and families To complete
More informationLORAIN COUNTY COURT OF COMMON PLEAS LORAIN COUNTY, OHIO STATE OF OHIO * CASE NO. Plaintiff, * JUDGE
If you want your criminal record sealed and unavailable to the public, carefully review sections 2953.31, 2953.32, 2953.321, 2953.33, 2953.34, 2953.35, 2953.36, 2953.37, 2953.38, 2953.53, 2953.54, 2953.56,
More informationName Last First M.I. Would you be interested in your application packet being forwarded to the TERO Office to be included in a job
Keweenaw Bay Indian Community 16429 Beartown Road, Baraga, Michigan 49908 Phone: (906) 353-6623 Personnel Office Fax: (906) 353-8068 APPLICATION FOR EMPLOYMENT Federal law requires that all applications
More information2809 University Avenue - Green Bay, WI
2809 University Avenue - Green Bay, WI 54311 920-884-7360 TENANT SELECTION CRITERIA Revised July 14, 2014 Eligible applicants must meet eligibility income limits with preference given to those eligible
More informationComplete one Personal History Form.
Two Original Applications Personal History Form Lease or Valid Document Photographs Corporate Papers Letters of Reference Financial Investments Please write legibly in BLACK ink or type information. Answer
More informationEQUAL HOUSING OPPORTUNITY
Management Company ROHLFFS MANOR 2400 Fair Drive Napa, CA 94558 Phone: 707.255.9555 Fax: 707.255.9577 TDD: 1.800.735.2929 CalBRE Lic #00853485 HI Lic. RB-16985 WAITING LIST INSTRUCTIONS 1. Submit 1 application
More informationKODIAK ISLAND HOUSING AUTHORITY 3137 MILL BAY ROAD, KODIAK, AK (907) or (800) within Alaska
KODIAK ISLAND HOUSING AUTHORITY 3137 MILL BAY ROAD, KODIAK, AK 99615 (907) 486-8111 or (800)478-5442 within Alaska Information required with Student Rental Assistance Application The following information
More informationPERSONAL DATA Last Name First Middle Social Security No.
APPLICATION FOR EMPLOYMENT CITY OF BRIDGEPORT 900 THOMPSON STREET BRIDGEPORT, TEXAS 76426 The City of Bridgeport is an Equal Opportunity Employer. It is the policy of the City of Bridgeport to provide
More informationEMPLOYMENT APPLICATION
D & H Drug Store EMPLOYMENT APPLICATION D & H Drug Store is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion,
More informationName Social Sec. No. - - LAST FIRST MI Present Address STREET City STATE ZIP Permanent Address. Telephone No.( ) Referred by?
47 TH DISTRICT COURT 31605 WEST 11 MILE RD. FARMINGTON HILLS, MI 48336 Telephone: 248-871-2900 Fax: 248-871-2901 www.ci.farmington-hills.mi.us/services/47thdistrictcourt/employmentopps.asp APPLICATION
More informationWoodlands Senior Park
Woodlands Senior Park EMPLOYMENT APPLICATION Woodlands Senior Park is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex,
More informationHotel Alder 415 SW Alder Portland, OR Phone: (503)
Hotel Alder 415 SW Alder Portland, OR 97204 Phone: (503) 525-8483 Tenant Selection Plan Section 8 1. Project Description: The Hotel Alder Building ( Property ) is a 99 unit Section 42 housing project managed
More informationEmployment Application
Employment Application Taos Integrated School of the Arts 123 Manzanares Road Post Office Box 668 Taos, New Mexico 87571 (575)758-7755 Fax (575)758-7766 GENERAL INSTRUCTIONS PLEASE NOTE: POSTION APPLYING
More informationOFFICE OF THE PUBLIC DEFENDER
OFFICE OF THE PUBLIC DEFENDER COURTHOUSE SQUARE 100 WEST BEAU STREET, SUITE 605 WASHINGTON, PENNSYLVANIA 15301 Phone Number: {724} 228-6818 FAX NUMBER: (724) 250-6516 IF YOU ARE PLANNING TO MAKE APPLICATION
More informationNote to Internet User: If you are acting as your own attorney (that is, if you are Pro Se ), scroll down to find blank forms you may use.
Note to Internet User: If you are acting as your own attorney (that is, if you are Pro Se ), scroll down to find blank forms you may use. The following forms are available below: 1. Motion form (and an
More informationKOOTENAI HOUSING AUTHORITY OF THE FLATHEAD RESERVATION
SALISH KOOTENAI HOUSING AUTHORITY OF THE FLATHEAD RESERVATION Dear Applicant, Attached is an application for Housing Rehabilitation Assistance(HIP). You must fill in all the blanks, please print as clearly
More informationAPPLICATION FOR HOUSING WAIT LIST
PROVIDENCE STAFF USE ONLY Date/Time Received: Staff Initials: Vincent House 1423 First Avenue, Seattle WA 98101 Phone: 206-682-9307 Fax: 206-682-0548 TTY: 800-833-6388 WA Relay: 711 APPLICATION FOR HOUSING
More informationApplication for Benefits
Georgia Department of Human Resources Application for Benefits What Services Do You Offer at the Department of Family and Children Services (DFCS)? DFCS offers the following services: Food Assistance Food
More informationAPPLICATION FOR EMPLOYMENT Allegany County Community Opportunities and Rural Development (ACCORD) Corporation
APPLICATION FOR EMPLOYMENT Allegany County Community Opportunities and Rural Development (ACCORD) Corporation We consider applicants for all positions on the basis of qualifications without regard to race,
More informationSuperior Court of California, County of Contra Costa. Fee Waiver Packet. (Guardianship and Conservatorship) What you will find in this packet:
Superior Court of California, County of Contra Costa Fee Waiver Packet (Guardianship and Conservatorship) What you will find in this packet: Information Sheet on Waiver of Court Fees and Costs (FW-001-INFO)
More informationAPPLICATION FOR SUPPORT PERSONNEL PLEASE READ THIS INSTRUCTION SHEET CAREFULLY
VERNON PARISH SCHOOL SYSTEM 201 BELVIEW ROAD LEESVILLE, LA 71446 337-239-3401 FAX 337-239-7507 APPLICATION FOR SUPPORT PERSONNEL **************************************************************** PLEASE
More informationNO MAILED IN OR FAXED APPLICATIONS WILL BE ACCEPTED
TO: FROM: All Applicants Betty M. Valdez, Housing Director DATE: March 26, 2011 RE: WAITING LIST APPLICATION INSTRUCTIONS ATTACHED YOU WILL FIND DIRECTIONS FOR COMPLETING AN APPLICATION FOR OUR HOUSING
More informationPROTECTION FROM ABUSE APPLICATION CONTACT INFORMATION SHEET FOR DISTRICT ATTORNEYS OFFICE USE ONLY
PLAINTIFF S INFORMATION Name (full): DOB: SSN: Address: Work Place: Home Phone #: Cell #: Work #: PROTECTION FROM ABUSE APPLICATION CONTACT INFORMATION SHEET FOR DISTRICT ATTORNEYS OFFICE USE ONLY Emergency
More informationPETITION FOR APPOINTMENT OF GUARDIAN FOR ADULT
District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Respondent Attorney or Party Without Attorney (Name and Address): Case Number: COURT USE ONLY Phone Number: E-mail:
More informationYouth Employment Program Referral and Application Packet Incomplete application packets will not be processed or returned.
Youth Employment Program Referral and Application Packet Incomplete application packets will not be processed or returned. POSITION: TEEN TEAMWORKS Urban Environmental Youthworker DUTIES: To perform the
More informationPROFESSIONAL APPLICATION Main and Mitchell Road P. O. Box 288 Booker, TX Ph: (806)
BOOKER INDEPENDENT SCHOOL DISTRICT PROFESSIONAL APPLICATION Main and Mitchell Road P. O. Box 288 Booker, TX 79005 Ph: (806) 658-4501 We consider applicants for all positions without regard to race, color,
More informationCITY OF SAYRE, OKLAHOMA AN EQUAL OPPORTUNITY EMPLOYER
CITY OF SAYRE, OKLAHOMA AN EQUAL OPPORTUNITY EMPLOYER PRE-EMPLOYMENT POLICE DEPARTMENT APPLICATION We make decisions regardless of race, color, religion, sex, national origin, age, marital or veteran status,
More informationEXHIBIT 1 BILOXI MUNICIPAL COURT PROCEDURES FOR LEGAL FINANCIAL OBLIGATIONS AND COMMUNITY SERVICE
No person shall be imprisoned solely because she/he lacks the resources to pay a fine, state assessment, fee, court cost, or restitution (collectively, legal financial obligation or LFO ), or because she/he
More informationVIOLENCE AGAINST WOMEN ACT (VAWA)
I. Purpose and Applicability MARSHALL HOUSE APARTMENTS VIOLENCE AGAINST WOMEN ACT (VAWA) POLICY & PROCEDURES The purpose of this policy (herein called Policy ) is to implement the applicable provisions
More informationKATHERINE K. HANNA JUSTICE OF THE PEACE, PCT. #3 BASTROP COUNTY, TEXAS
KATHERINE K. HANNA JUSTICE OF THE PEACE, PCT. #3 BASTROP COUNTY, TEXAS THESE INSTRUCTIONS ARE A BROAD INTERPRETATION OF THE LAWS THAT APPLY TO EVICTIONS IN THE JUSTICE COURT, TEXAS RULES OF CIVIL PROCEDURE
More informationEMPLOYMENT APPLICATION
EMPLOYMENT APPLICATION TRI-STATE REGIONAL AMBULANCE, INC. 235 CAUSEWAY BLVD. LA CROSSE, WI 54603-3119 608-519-3345 608-782-4522 fax sweber@tristateambulance.org www.tristateambulance.org Tri-State Regional
More informationCHAPTER 2 ELIGIBILITY FOR ADMISSION. [24 CFR Part 5, Subparts B, D & E; Part 982, Subpart E]
CHAPTER 2 ELIGIBILITY FOR ADMISSION [24 CFR Part 5, Subparts B, D & E; Part 982, Subpart E] INTRODUCTION: This chapter defines both HUD and the NBHA s criteria for admission and/or denial of admission
More informationAPPLICATION FOR HOUSING ASSISTANCE
APPLICATION FOR HOUSING ASSISTANCE Thank you for your interest in Lawrence-Douglas County Housing Authority (LDCHA). This application can be used to request placement on our core waiting lists. Applicants
More informationIN THE COURT OF COMMON PLEAS OF CLEARFIELD COUNTY, PENNSYLVANIA CIVIL DIVISION rev
INSTRUCTIONS FOR COMPLETING AFFIDAVIT IN SUPPORT OF PETITION TO PROCEED IN FORMA PAUPERIS (IFP) [CIVIL & FAMILY LAW CASES] IF YOU FEEL THAT YOU CANNOT AFFORD THE FILING FEES AND COSTS ASSOCIATED WITH YOUR
More informationADMINISTRATIVE OFFICE
ADMINISTRATIVE OFFICE RICHLAND SATELLITE OFFICE 1915 W. 4 th Place 431 Wellsian Way Kennewick, WA 99336 Richland, WA 99352 Phone: (509) 586-8576 Phone: (509) 586-8576 TTY: (509) 586-4460 TTY: (509) 586-4460
More informationApplication to Rent Complete the application form. We require an application for each proposed adult (age 18 or older) resident.
RENTAL APPLICATION CHECKLIST Use this handy list to organize your application papers. Check the box of each item you re submitting. Mail your completed application to P.O. Box 16, Chico, CA 95927 or scan
More informationUNIVERSAL PRELIMINARY APPLICATION FOR HIV/AIDS HOUSING (Revised September, 2004) COVER PAGE
UNIVERSAL PRELIMINARY APPLICATION FOR HIV/AIDS HOUSING (Revised September, 2004) COVER PAGE CHECK LIST: This application requires the following to be complete. Applicant should retain a copy. Complete
More informationImportant Definitions
Important Definitions Adjudication: a formal court judgement in a juvenile delinquency case. It is like being guilty in an adult case. Arrest: when the police take a person into custody. Conviction: a
More informationName Social Security No. Mailing Address Physical Address. City State Zip Phone ( ) Work Phone ( ) . First Choice Second Choice
Heber-Overgaard Unified School District #6 P.O. Box 547; 3375 Buckskin Canyon Heber, Arizona 85928 Telephone (928) 535-4622 Fax (928) 535-5146 Email: HR@h-oschools.org www.heberovergaardschools.org APPLICATION
More informationChapter 3 ELIGIBILITY
INTRODUCTION Chapter 3 ELIGIBILITY The PHA is responsible for ensuring that every individual and family admitted to the public housing program meets all program eligibility requirements. This includes
More informationCUSTODY PACKET IMPORTANT!!!
CUSTODY PACKET IMPORTANT!!! YOU ARE RESPONSIBLE FOR SERVICE of the Complaint, Notice, Order, a copy of your completed Criminal Record/Abuse History Verification, as well as a blank Criminal Record/Abuse
More informationPersonal Declaration. 2. Household Information. Answer all questions about your household.
Personal Declaration Any individual with a dability or other medical need who needs accommodation with respect to th form should inform San Francco Housing Authority. Instructions for completing th form:
More informationTHE REQUIREMENTS FOR ALCOHOLIC BEVERAGE APPLICATION MUST BE A UNITED STATES CITIZEN ANYONE THAT OWNS 20% OR MORE OF THE BUSINESS +THE MANAGER
THE REQUIREMENTS FOR ALCOHOLIC BEVERAGE APPLICATION MUST BE A UNITED STATES CITIZEN ANYONE THAT OWNS 20% OR MORE OF THE BUSINESS +THE MANAGER THE COST: Fingerprint record for each person (Licensee & Manager)
More informationAPPLICATION FOR EMPLOYMENT
APPLICATION FOR EMPLOYMENT For Human Resources Use Only License Class: Gaming n-gaming Meskwaki Bingo Casino Hotel is an equal opportunity employer subject to our Tribal Preference Policy. All applicants
More informationROUGH ROCK COMMUNITY SCHOOL, INC. HC 61 Box 5050 PTT Rough Rock, Arizona Phone: (928)
ROUGH ROCK COMMUNITY SCHOOL, INC. HC 61 Box 5050 PTT Rough Rock, Arizona 86503 Phone: (928) 728 3700 CLASSIFIED EMPLOYMENT APPLICATION Date: Please complete entire application in full. Do not use refer
More informationCRIMINAL RECORDS SCREENING AND FAIR HOUSING. A Toolkit for Consumers
CRIMINAL RECORDS SCREENING AND FAIR HOUSING A Toolkit for Consumers THE EQUAL RIGHTS CENTER The Equal Rights Center is a civil rights organization that identifies and seeks to eliminate unlawful and unfair
More informationADULT GUARDIANSHIP QUESTIONNAIRE
CATHERINE E. DAVEY, J.D., LL.M. Post Office Box 941251 Maitland, Florida 32794-1251 Telephone (407) 645-4833 Facsimile (407) 645-4832 ADULT GUARDIANSHIP QUESTIONNAIRE A. INFORMATION ABOUT THE ALLEGED INCAPACITATED
More informationAPPLICATION FOR HOUSING WAIT LIST
PROVIDENCE STAFF USE ONLY Date/Time Received: Staff Initials: APPLICATION FOR HOUSING WAIT LIST We do not have any vacancies at this time. To be placed on our wait list(s), please complete this application,
More informationSanco Pipelines, Inc. Employment Application An Equal Opportunity Employer
Sanco Pipelines, Inc. Employment Application An Equal Opportunity Employer Please Print Date Last Name First Name Middle Present Address - No. & Street City State Zip Permanent Address (if different from
More informationCourt Appointed Special Advocate Volunteer Application Shoals CASA
PLEASE PRINT LEGIBLY CASA is an Equal Opportunity Organization. You must be at least 21 to become a CASA Volunteer. Name: Aliases/Maiden Name: Current Address: Residence address, if different: City, State,
More informationDistrict Office 2083 College Avenue Elmira Heights, NY Mary Beth Fiore, Superintendent
EMPLOYMENT APPLICATION District Office Mary Beth Fiore, Superintendent Phone: (607) 734 7114 Fax: (607) 734 7134 CSE: (607) 734 5078 Transportation: (607) 739 1358 www.heightsschools.com Bus Driver Bus
More informationWARDLE FAMILY YMCA OF BEAUFORT COUNTY EMPLOYMENT APPLICATION
WARDLE FAMILY YMCA OF BEAUFORT COUNTY EMPLOYMENT APPLICATION Thank you for your interest in the YMCA! The YMCA is an equal opportunity employer and does not discriminate in recruitment, hiring or other
More informationYours, (sign your name) PRINT your name your address including city, state and zip code telephone number
APPELLATE TERMS OF THE SUPREME COURT 2nd, 11th & 13th and 9th & 10th JUDICIAL DISTRICTS V. NOTICE OF MOTION FOR LEAVE TO APPEAL AS A POOR PERSON (CIVIL) Appellate Term Docket No. Please take notice that
More informationChapter 2 ELIGIBILITY FOR ADMISSION. [24 CFR Part 960, Subpart B]
Chapter 2 ELIGIBILITY FOR ADMISSION [24 CFR Part 960, Subpart B] INTRODUCTION This Chapter defines both HUD s and the PHA s criteria for admission and denial of admission to the program. The policy of
More informationAcademy District 20 Non-Parent Volunteer Application Form. Process Information for Principals
Process Information for Principals Selection of and number of volunteers is at the discretion of the principal. Definition of a Non-Parent Volunteer: An individual over the age of 18 who does not have
More informationCity of McHenry Application for Employment
City of McHenry Application for Employment Please return to: Office of Human Resources 333 S. Green St. McHenry, IL 60050 The City of McHenry is an Equal Employment Opportunity Employer. We consider applicants
More informationJOINT APPLICATION TO WAIVE FEES AND COSTS F-6JP
Do Not File Or Copy This Page JOINT APPLICATION TO WAIVE FEES AND COSTS F-6JP Self Help Center 1 South Sierra St., First Floor Reno, NV 89501 775-325-6731 www.washoecourts.com Do Not File Or Copy This
More informationPETITION FOR EMERGENCY TEMPORARY PROTECTIVE ORDER
PETITION FOR EMERGENCY TEMPORARY PROTECTIVE ORDER (Note: This form is for use when the Court is NOT open for business) District Court Choctaw Nation of Oklahoma Court Phone Number (918) 567-3582 Petitioner
More informationDRIVER S APPLICATION FOR EMPLOYMENT
DRIVER S APPLICATION FOR EMPLOYMENT Applicant Name (Print) Date of Application LuGreg Trucking, LLC P. O. Box 1289, 22476 N 2860 RD Kingfisher, OK 73750 In compliance with Federal and State equal employment
More informationREQUIREMENTS FOR EMPLOYMENT: To Be Provided By Applicant ***THESE DOCUMENTS ARE MANDATORY AND WILL BE VERIFIED AT THE TIME OF INITIAL INTERVIEW.
REQUIREMENTS FOR EMPLOYMENT: To Be Provided By Applicant 1. COPY OF HIGH SCHOOL OR COLLEGE TRANSCRIPT 2. VAILD NORTH CAROLINA DRIVERS LICENSE 3. SOCIAL SECURITY CARD 4. YEARLY TB SKIN TEST 5. COPY OF CURRENT
More informationIN THE DISTRICT COURT OF TULSA COUNTY STATE OF OKLAHOMA. THE STATE OF OKLAHOMA, ) Plaintiff, ) Case No.: ) vs. ) Judge/CF Docket ), ) ) Defendant.
IN THE DISTRICT COURT OF TULSA COUNTY STATE OF OKLAHOMA THE STATE OF OKLAHOMA, Plaintiff, Case No.: vs. Judge/CF Docket, Defendant. DEFENDANT PACKET FOR OBTAINING APPROVAL OF PAYMENT AT PUBLIC EXPENSE
More information