Please return this completed form to the management office of the Village (address listed below)

or fax it to us at 720.962.8201

(Please call 303.985.0374 prior to sending any faxes)

Applicant Screening Request

Administrative Information

This information is required to process this application.

Rental Services Customer: THE VILLAGE APARTMENTS

Rental Property Address: 10250 West Mississippi Avenue #1000 Lakewood Colorado 80226

Contact Name: Josey Lucero	Title: Community Manager

Phone: 303.985.0374	Fax: 720.962.8201	E-mail address: thevillageapts@comcast.net

Type of report requested – please check one:

[ ]	Eviction and Credit Only

[ ]	Eviction and Credit Plus Criminal Check

[ ]	Full Application Screening

[ ]	Full Application Screening Plus Criminal Check

Applicant Screening Request Form

Please print clearly. All fields must be completed.

Name:	DOB:	SS#:

Co-Applicant:	DOB:	SS#:

Applicant's Contact #:	Alt #:

Rental History

Landlord Name:	Landlord's #:

Applicant's Current Address:

Lease Dates:	Rental Rate:

Please Complete Page 2

If you have been at the above residence less than two (2) years, please complete section below.

Previous Landlord Name:	Landlord's #:

Applicant's Previous Address:

Lease Dates:	Rental Rate:

Employment History

Employer:	Employer's #:

Title/ Position:

Contact Name:	Contact #:

Dates of Employment:	Salary/ Hourly Wage:

If you have worked for the above employer for less than one (1) year, please complete the section below.

Previous Employer:	Employer's #:

Title/ Position:

Contact Name:	Contact #:

Dates of Employment:	Salary/ Hourly Wage:

Spouse's Employer:	Employer's #:

Title/ Position:

Contact Name:	Contact #:

Dates of Employment:	Salary/ Hourly Wage:

Please Complete Page 3

Authorization of Release

To Whom It May Concern:

I hereby allow Rental Services, Inc. to verify my employment and rental reference(s) and/ or run a credit and criminal history check. I am aware that they may ask several questions regarding my background and I give them my permission to do so.

Please be advised that I,	, authorize release of information to
Rental Services, Inc., your prompt response to any/ all questions is greatly appreciated.

Applicant's Signature:	Date:

Co-Applicant's Signature:	Date: