First name: ____________________

Middle in: ____________________

Last name: ____________________
Current address: ____________________ City: ____________ State: ___ Zip: _______
Contact number: ____________________
E-mail address: __________________________________
_____________________________________________________________________________________
Date of Birth: ____________________
Age: _________
_____________________________________________________________________________________
Do you have anybody that will be staying with you? If yes, list their age: ____________________
Is any of your family members disable? ______________
Does anyone in your household smokes pot, meth, or any other drugs? ____________________
Does any person in your household have a FELONY: If so, when did they receive it? ____________
Are you on TANF, Section 8, or Ware-Fare? ____________________
How often do you stay in police contact? ____________________
How often do you have events at your location? ____________
_____________________________________________________________________________________
Current work: ____________________________
Work number: ____________________
Work address: ____________________ City: ______________ State: ____ Zip: _________
Supervisor number: ______________________________
Hourly pay/salary: ____________________
Start date: ____________________
End date: ____________________
Full time or part time? ____________________
________________________________________________________________

Payment instructions are at the bottom of the application.
________________________________________________________________
This background check will pull up if you owe any fees to houses/apts you have recently stayed in from
the last past years of 2003-2014; this background check will probably also check your criminal
background, TICKETS DOES NOT MATTER. Federal law says that a person who is subject to lifetime
sex offender registration or who has been convicted of producing methamphetamine on public housing
grounds may not ever be admitted to public housing again. Ladonna does work with sex offender and
felonies. If you are a sex offender, you will NOT be able to move in the unit if there are toddlers located
around the unit. If you have any inventions in your name, there will be agreements before moving in, and
you'll have to pay an extra fee of $5.00 added onto your monthly rent. There will be a fee of $35 to do the
background check also.
NOTE: please attach your state I.D. to your application. The system has updated so you need to attach
your I.D. to the application or email. Your I.D. has to be clear so the system verify your name and
address.
For the payment, you have to send the application fee through Popmoney to stt495@gmail.com If the
system dont receive the application fee within 24 hours, then your application will be removed
automatically from the system or the application fee will get put on your record (as a unpaid fee) if the
system decides to continue the process.
Please follow the payment steps:
Go to www.popmoney.com and set up an account
Click on Send Money
To: stt495@gmail.com
Amount: $35
Send Date: Today
For: Donation
Click on Next
Complete your card information
Make sure you type in DONATION (where it says for), because the payment will not go through if you dont type
in donation for whats the payment is for, your payment will just pend if you dont do the payments steps correct,
and the system will not be able to continue the process of your background check if your payment is pending. After
you submitted your application fee, the system will send you an email to confirm that your application has been
submitted and youll receive a receipt within the time you submitted your application to six hours. With the payment
steps, it is important to follow the steps because if you do not follow the payment steps, then your payment might
get sent back to you or might be put on a hold for twenty-one days. In the payment steps for number five, if you do
not put for donation, then your payment will get send back to the account that it was sent from automatically
because the system has certain word phrases that is used for application fees, rent, and security deposits.