CONNECTICUT RENTAL APPLICATION FORM

Property Address: _________________________________________________
Unit/Apartment Number (if applicable): ___________________________
Desired Move-In Date: ___________________________
Lease Term: ________________ months/years

Applicant Information

Full Name: ______________________________________________________
Date of Birth: ___________________________
Social Security Number (if applicable): ___________________________
Driver’s License/ID Number: ________________ State: ____________
Phone Number: ___________________________
Email Address: ___________________________
Current Address: _________________________________________________
City/State/ZIP: _________________________________________________
How Long at This Address? ___________________________
Landlord/Property Manager: ___________________________
Phone: ___________________________
Reason for Leaving: _________________________________________________
Previous Address: _________________________________________________
City/State/ZIP: _________________________________________________
How Long at This Address? ___________________________
Landlord/Property Manager: ___________________________
Phone: ___________________________
Reason for Leaving: _________________________________________________

Employment & Income Information

Current Employer: _________________________________________________
Employer Address: _________________________________________________
Position/Title: ___________________________
Supervisor’s Name: ___________________________
Phone: ___________________________
Length of Employment: ___________________________
Monthly Income (Gross): $___________________________
Previous Employer (if less than 1 year at current job): ____________________________________
Employer Address: _________________________________________________
Position/Title: ___________________________
Supervisor’s Name: ___________________________
Phone: ___________________________
Length of Employment: ___________________________
Monthly Income (Gross): $___________________________

Other Sources of Income

Source: _________________________________________________
Amount: $__________________________
Frequency: ___________________________
Co-Applicants/Occupants (18 years or older)
Full Name: ______________________________ Relationship: ___________
SIMPLE FORMS
Full Name: ______________________________ Relationship: ___________
Full Name: ______________________________ Relationship: ___________
Total Number of Occupants (including minors): ___________________________
Vehicle Information
Vehicle Make/Model: ___________________________ Year: ___________
License Plate #: ___________________________ State: ___________
Vehicle Make/Model: ___________________________ Year: ___________
License Plate #: ___________________________ State: ___________

Pets

Do you have pets? ☐ Yes ☐ No
If yes, describe (type/breed/weight): ___________________________________________

References

Personal Reference (non-family): ___________________________
Phone Number: ___________________________
Relationship: ___________________________
Emergency Contact: ___________________________
Phone Number: ___________________________
Relationship: ___________________________

Consent and Certification

I/we certify that the information provided in this application is true and complete to the
best of my/our knowledge. I/we authorize the landlord/manager to verify the information
provided, including credit history, employment, and rental history.

Applicant Signature: ____________________________________ Date: ___________
Co-Applicant Signature: _________________________________ Date: ___________