Part 1: Landlord Rental Application & Background Check Consent (1)

Part 1: Landlord Rental Application & Background Check Consent

Employment/ Contract Application


Date: ________________________

Applicant:
Full name – please include all names you use(d): _____________________________
Home phone: __________________ Cell phone: __________________Cell Provider: __________________ Email:______________________

Massage License #_____________________

Massage Insurance Provider and Policy #____________

Please provide a photocopy of your driver’s license, massage insurance, massage license.


Employment/ Contractor History (in U.S. or any other country):

Name and address of current employer: ____________________________________
_______________________________ Phone: __________________
Name of supervisor: __________________ Supervisor’s phone: ________________
Dates employed at this job: __________________ Position or title: ______________

Name and address of previous employer:____________________________________
_______________________________ Phone: __________________
Name of supervisor: __________________ Supervisor’s phone: ________________
Dates employed at this job: __________________ Position or title: ______________


Have you ever (in U.S. or any other country):
Filed for bankruptcy? _____
Been sued? _____
Sued someone else? _____
Been evicted? _____
Been convicted of a crime: _____

Please explain any “yes” listed above:



References and emergency contact (at least one must be local):
Personal reference: ___________________________ Relationship: ___________________
Address: __________________________________________________________________
Phone: __________________

Personal reference: ___________________________ Relationship: ___________________
Address: __________________________________________________________________
Phone: __________________

Contact in emergency: ___________________________ Relationship: _________________
Address: ___________________________________________________________________
Phone: __________________

I certify that all the information given above in this Employment/ Contractor Application is true and correct and understand that my Contractor Agreement may be terminated and legal action may ensue. if I have made any false or incomplete statements in this Application. For the purpose of evaluating this Application and for the collection and recovery of any financial obligations relating to my contractual obligations, I authorize verification of the information provided herein from current and previous employers, schools, and personal references.


________________________________________ __________, 2013
Applicant Name

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