Application | Little Rock Affordable Rental House

If the field with * is not filled, the application cannot be submitted

Property Address *

Move-In-Date *

Your Name (First, Middle, Last) *

Other names used in the past 10 years *

Date of birth *

Social security # *

Driver license # and State *

Phone # (cell, work) *

Email address *

Marital status *

Single
Married
Divorced
Separated
Widowed
Other

List name, age, and relationship of ALL persons who will reside with you. If no other person, write "self"

Have you ever done the following: (check, if YES) *

Been evicted or requested to vacate?
Had your wages garnished?
Had security deposit not returned?
Are you subject to being transferred by your job?
Do you have any history of drug use or offenses?
been sued for damage to rental property?
Do you smoke?
do you have any pet?
Refused to pay rent?
Been arrested or convicted?
Broken a lease?
Do you know of anything that may interrupt your ability to pay rent?
Is there anything to prevent you from placing utilities in your name?
Ever declared Bankruptcy?
None of the above

Are you employed? *

Yes
No
Self employed

If yes, current employer's name *

Current employer's address *

Current employe's phone number *

Current employment Dates (from___) *

Current Monthly NET income/position/supervisor *

Previous employer's name *

Previous employer's address *

Previous employer's phone number *

Previous employment Dates (From_____To_____) *

Previously employment: monthly Net income *

Previously employment: position *

Previously employment: supervisor *

Do you have money available to pay the security deposit and First month's rent in full? *

Yes
No

In the event of an emergency that would prevent you from paying rent, is there a relative, person, or agency that could assist you with rent payments? List Emergency Contact name, address, phone and relationship: *

Car loan/Lien holder: Balance owed, monthly payment, creditor's phone #:

Furniture rental: balance owed, monthly payment, phone#:

Child support/other credit owed: balance owed, monthly payment, creditor's phone:

Rental history: Current address *

Current landlord's name *

Current landlord's phone# *

Current rental dates (From_____) *

Current rent (Including amount of deposit) *

Reasons for moving *

Previous rental address *

Previous landlord's name *

Previous landlord's phone *

Previous rental dates (From____To_____) *

Previous rent (including amount of deposit) *

Reasons for moving *

References: name, address, phone, relationship: *

Nearest relative not living with you: name, address, phone, relationship:

Automobile: make/model, year, color, tag#, state:

Are you smoking? *

Yes
No

Do you have pet? *

Dog
Cat
None

Pets are allowed only at the discretion of the manager/representative/landlord and are required to complete a pet application.

Photocopy of your driver license *

Photocopy of your social security card *

Most recent two months paystub or other income information/W2/1 099's/1040 (if more than 1 file, please upload under "Additional files")

Two months bank statements (Account# is not required) (if more than 1 file, please upload under "Additional files)( *

Recent utility bills *

Additional files

Application Fee *

$40 for applicant with Arkansas ID
$50 for applicant with non-Arkansas ID
Pay through Zelle using 5016582828

Certification and Authorization *

I hereby certify that the answers I have given in this application are true and correct to the best of my knowledge. I understand that any false answers or statements made by me will be sufficient grounds for denial or eviction and loss of my security deposit. I authorize my present or past employers, landlords or their agents, banks, creditors, credit bureau, or personal friends to give or provide such information regarding my history or application with them or their organization as may be requested for the purpose of leasing property and collecting rents. I also authorize landlord to report credit or personal information to others regarding my status with them. I hereby authorize owner/agent to obtain unlawful detainer, credit reports, telechecks, and/or criminal background reports. I agree to furnish additional credit and/or personal references upon request. I fully agree that the application fee is for the purpose of verifying the information submitted on this application. It is understood that this sum is nonrefundable and can in no way be considered a deposit to hold the dwelling. It is agreed that other applications may have already been and will continue to be accepted.

Submit the application form and pay the required Application Fee using Zelle through 501-658-2828. The application will not be processed without paying the application fee.