TENANT BACKGROUND RELEASE FORM

LAST NAME

FIRST NAME
MID.INIT.
SOC.SEC#
DATE OF BIRTH

PRESENT ADDRESS

CITY,ST,ZIP

COUNTY

FROM

TO

LANDLORD'S NAME LANDLORD'S PHONE
LIST ALL CONVICTIONS INCLUDING TRAFFIC (Indicate "M" for misdemeanor or "F" for felony. )
YR. NATURE OF OFFENSE RESOLUTION WHERE(CITY/ ST COUNTY) M or F OTHERS: YR.
Present Employment: City/St Phone # Supv’r from to
Your Position: Monthly Earnings:
I hereby authorize the release to Tenant Check Bureau, Inc., (TCB ) an independent pre-rental screening agency, of any information held by any parties regarding my employment , criminal, credit and information regarding my general character and reputation. I release any providers of such information from any liability for providing same. I understand the information may be reviewed initially and periodically by TCB and reported to my prospective Landlord. I further acknowledge that TCB is relying on third party information and I therefore release TCB,, my prospective Landlord and their respective owners, officers, agents and employees from any and all liability arising out of errors or omissions.

NOTE:Your on-line submission asserts you have a signed applicant release on file.

COVER SHEET (LANDLORD USE ONLY) Fax: (859) 781-5888 Email: info@backgroundbureau.com call: (800) 854-3990 or ( 859) 781-3400

DATE

*CLIENT

ACC’T. #

ATT’N:

*PHONE

FAX TO #:

EMAIL TO:

     special

STANDARD COUNTY CRIMINAL HISTORY $20.00 FORMER COUNTY CRIMINAL HISTORY $20.00 BOTH $32.50

PRIOR LANDLORD INTERVIEW $10.00 VERIFY EMPLOYMENT $10.00

This form is property of Background Bureau,Inc. Unauthorized use is prohibited.