Housing Application (Mock-Up) check it out

FOUR COMMUNITY

Application for Housing

Name of applicant___________________________________________________

Birth date ________________________ Social Security # _____________________

Current Addres______________________________________________________

________________________________________________________________

Phone ______________________ Number of years at this address _______________

Previous address _____________________________________________________

______________________________________________________________________

Name of Co-applicant ____________________________________________________

Birth date __________________________ Social Security # _____________________

Current Address _________________________________________________________

______________________________________________________________________

Phone _______________________ Number of years at this address _______________

Previous address ________________________________________________________

List below all those who live in your home (including applicant and co-applicant):

Name	Relationship	Age	Male/Female

List below some ways in which you can contribute sweat equity by helping to

build your own home, the homes of others, or by helping with the work of Four Community organization.

I. Current Housing

Do you currently live in public housing? �� Yes �� No

Do you (check one): �� Own �� Rent �� other (explain)

Number of bedrooms _______________ Number of bathrooms _________________

Other rooms (check each) �� kitchen �� living room �� dining room �� storage area

Monthly rent or mortgage __________________________________________________

Name of Landlord or Mortgage holder ________________________________________

Address of Landlord or Mortgage holder ______________________________________

____________________________________________ Phone _________________

Describe below the condition of your current house and your current housing

Needs (attach additional sheets if necessary):

II. Employment Information

Provide the following information for all employed household members:

Household member ______________________________________________________

Name of Employer _______________________________________________________

Address of Employer _____________________________________________________

____________________________________________ Phone _________________

How long have you worked here? ________ Average gross monthly wage ___________

Is your job seasonal? ______ if yes, how many weeks of the year do you work? _______

Household member ______________________________________________________

Name of Employer _______________________________________________________

Address of Employer _____________________________________________________

____________________________________________ Phone _________________

How long have you worked here? ________ Average gross monthly wage ___________

Is your job seasonal? ______ if yes, how many weeks of the year do you work? _______

List below all other income including AFDC, Food Stamps, Social Security, Disability,

Child Support, Pension, Unemployment Compensation, Etc.

Person receiving Income	Kind of Income (AFDC, Food Stamps, Disability, etc.)	Monthly Amount

Name(s) and Address (es) of Bank(s) where you have checking and/or savings accounts:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Checking Account # ____________________ Savings Account # ______________

List below all debts including credit cards, mortgage, car, child support, etc.

Person/Company owed	Total Owed	Monthly Payment

III. References

Former Landlord ________________________________________________________

Address _______________________________________________________________

______________________________________________________________________

Phone ______________________ how long ago did you rent from this landlord? ____

Former Employer ________________________________________________________

Address _______________________________________________________________

______________________________________________________________________

Phone _________________ how long ago did you work for this employer? __________

Below, list at least two people not related to you who would be willing to give

Personal references for you:

Name _________________________________________________________________

Address _______________________________________________________________

____________________________________ Phone _______________________

Name _________________________________________________________________

Address _______________________________________________________________

____________________________________ Phone _______________________

Include below any information that you think is important for us to know about

Your family situation or need for housing (attach additional sheets if needed).

IV. Authorization and Release

The undersigned applicant(s) is applying for a Washington State Four Community

Home and a no-interest loan to finance the purchase price of the home. The

Applicant authorize(s) Four Community to evaluate the

Applicant’s actual need for housing, ability to repay the loan and other expenses of

Normal home ownership and willingness to participate in the Four Community Partnership program. This evaluation can include home visits, credit checks, reference checks,

Verification of information supplied in this application, verification of bank accounts,

And other information that will help with the selection process. The original or a copy

Of this application will be retained by Four Community even if the application is not approved. All information will be held in confidence.Signature of applicant __________________________________________________

Date _______________________________________________________________

Signature of Co-applicant _______________________________________________