Arkansas Rental Application

Property Address: [[Property Full Address]], [[City]], AR [[ZIP Code]]
Monthly Rent: [[Monthly Rent]]
Desired Move-In Date: [[Desired Move-In Date]]
Application Date: [[Application Date]]
Application / Screening Fee Amount: [[Application Fee Amount]] (non-refundable; reflects actual screening costs)

Landlord / Property Manager: [[Landlord or Management Company Name]]
Contact: [[Landlord Phone]] | [[Landlord Email]]

This Rental Application is used to evaluate applicants for tenancy at the above-referenced property. All information provided will be used solely for screening purposes in accordance with the federal Fair Housing Act (42 U.S.C. § 3601 et seq.), the Fair Credit Reporting Act (FCRA, 15 U.S.C. § 1681 et seq.), and Arkansas law.

Important Disclosures Before Completing

• Arkansas does not impose a statutory cap on rental application or screening fees. The fee disclosed above reflects the actual costs of screening (credit report, background check, eviction search, and related processing) and is non-refundable regardless of the approval decision.
• A consumer report (credit report, criminal background, eviction history, etc.) may be obtained.
• You have the right under FCRA to a copy of any consumer report obtained and to dispute inaccurate information.
• If an adverse action (denial, conditional approval, or requirement of additional deposit or guarantor) is taken based in whole or in part on information in a consumer report, you will receive an adverse action notice with a copy of the report and a summary of your FCRA rights.
• This application does not create a tenancy or guarantee approval. All decisions are based on objective, consistently applied screening criteria that comply with the Fair Housing Act. No questions are asked that would elicit information about protected classes (race, color, religion, sex, national origin, familial status, or disability).
• All user-supplied values are `[[Token Name]]` placeholders., -

1. Applicant personal / contact information and residency history

Applicant Full Legal Name: [[Applicant Full Name]]
Date of Birth: [[Date of Birth]]
Social Security Number (last 4 for verification): [[SSN Last 4]] (full SSN required on consent page)
Driver's License / Government ID State & Number: [[DL State and Number]]
Current Phone: [[Applicant Phone Number]]
Email Address: [[Applicant Email Address]]
Current Address: [[Current Street Address, City, State, ZIP]]
How long at current address: [[Duration at Current Address]]

Previous Addresses (past 3-5 years, attach additional sheet if needed)

Emergency Contact
- Name: [[Emergency Contact Full Name]]
- Relationship: [[Relationship]]
- Phone: [[Emergency Contact Phone]]

Other Occupants (all adults and children who will reside in the unit)
[[List full names, ages, and relationship for all proposed occupants or state "None other than applicant(s)"]]

Vehicles to be parked on premises (if parking provided)
[[Year/Make/Model and License Plate for each vehicle or "None"]], -

2. Government ID / SSN and consent / authorization for background and credit check (FCRA disclosure)

Authorization and Release for Consumer Reports

I authorize [[Landlord or Management Company Name]] and its screening agents or consumer reporting agencies to obtain consumer reports, including but not limited to credit reports, criminal background checks, eviction history, sex offender registry, employment and income verification, and rental history, for the purpose of evaluating this rental application.

I understand that:
- This is a consumer report as defined by the Fair Credit Reporting Act (15 U.S.C. § 1681).
- If any adverse action (denial, conditional approval, or increased deposit) is taken based in whole or in part on information in a consumer report, I will be provided a copy of the report and a summary of my rights under FCRA.
- I may obtain a free copy of my credit report annually at www.annualcreditreport.com.
- I may dispute inaccurate information directly with the consumer reporting agency.

Full Legal Name (as appears on ID): [[Applicant Full Name]]
SSN: [[Full Social Security Number, will be redacted after screening]]
Date of Birth: [[Date of Birth]]
Current Address for Report: [[Current Address]]

Applicant Signature / Electronic Signature Authorization

By signing below (or checking the electronic consent box), I certify that all information provided is true and complete to the best of my knowledge, and I authorize the procurement of consumer reports as described.

Signature: _______________________________ Date: [[Signature Date]], -

3. Employment and income verification

Current Employer: [[Current Employer Name]]
Employer Address: [[Employer Address]]
Position / Job Title: [[Job Title]]
Dates of Employment: [[Employment Start Date]] to Present (or [[End Date if applicable]])
Supervisor / HR Contact: [[Supervisor or HR Name and Phone]]
Gross Monthly Income: $[[Gross Monthly Income]]

Previous Employer (if current employment < 2 years): [[Previous Employer Name]]
Dates: [[Prev Employment Dates]]
Gross Monthly Income at Previous: $[[Prev Gross Monthly Income]]

Other Income Sources (e.g., alimony, child support, disability, investments, optional and not required unless relied upon for qualification)
[[Describe other stable income sources and amounts or "None"]]

Income Documentation to be Provided (as requested): [[Pay stubs, W-2s, tax returns, bank statements, award letters, etc.]]

1. All income information is provided voluntarily to demonstrate ability to pay rent.
2. Screening criteria regarding income will be applied consistently (e.g., gross income typically 2.5, 3x rent or other objective standard disclosed in advance).
3. Self-employed applicants may be required to provide additional documentation such as tax returns or profit-and-loss statements., -

4. Rental history and landlord references

Current / Most Recent Landlord or Property Manager
- Name: [[Current Landlord Name]]
- Phone / Email: [[Landlord Contact]]
- Address of rental: [[Prior Rental Address]]
- Dates of tenancy: [[Tenancy Dates]]
- Monthly rent: $[[Prior Monthly Rent]]
- Reason for leaving: [[Reason]]

Second Prior Landlord Reference
- Name: [[Second Landlord Name]]
- Phone / Email: [[Second Landlord Contact]]
- Tenancy dates and address: [[Details]]
- Monthly rent and payment history notes: [[Details]]

1. Landlord references will be contacted to verify payment history, lease compliance, and condition of premises upon move-out.
2. Applicant authorizes prior landlords to release information about tenancy performance.
3. Any eviction filings, lease violations, or outstanding balances will be considered in the objective screening process.

Pets / Assistance Animals (if applicable)
[[Describe pets: type, breed, weight, age, number or "No pets" or "Assistance animal, documentation attached if requested"]]

Smoking Policy Preference / Disclosure
[[Smoker / Non-smoker / Will comply with property smoking policy]], -

5. The Arkansas-allowed application / screening fee (no statutory cap, disclose amount and non-refundability)

Application / Screening Fee: $[[Application Fee Amount]]

This fee is charged to cover the actual costs incurred to obtain and review consumer reports, verify employment and income, contact references, and process the application. Arkansas law does not set a maximum fee; the amount charged is a good-faith estimate of actual out-of-pocket and administrative screening costs.

1. The fee is non-refundable whether the application is approved, denied, or withdrawn.
2. A receipt or acknowledgment of payment will be provided upon request.
3. If multiple applicants apply together, each adult applicant may be charged a separate fee or a single combined fee as disclosed by the landlord.

Payment Method for Fee: [[Cash / Check / Money Order / Online Portal / Other]], -

6. Screening criteria (income multiple, credit, eviction/criminal per HUD fair-housing guidance)

The landlord uses objective, consistently applied screening criteria that do not discriminate on the basis of race, color, religion, sex, national origin, familial status, disability, or other protected characteristics under the federal Fair Housing Act or Arkansas law.

Typical (but not exhaustive) factors considered:

1. Income: Gross monthly income sufficient to meet published minimum multiple of rent (e.g., 2.5x or 3x) after accounting for other obligations.
2. Credit history: Minimum credit score threshold or review of payment patterns, collections, and bankruptcies (adverse information will be considered individually).
3. Rental history: No prior evictions within a defined look-back period, or satisfactory explanations and references.
4. Criminal background: Convictions for certain offenses (e.g., violent crimes, sex offenses, or drug manufacturing/distribution on premises) may result in denial consistent with HUD guidance on individualized assessment.
5. Eviction search and court records within applicable jurisdictions.

The specific numerical thresholds and look-back periods will be provided in writing upon request before the application fee is paid, or are stated in the property's rental criteria sheet.

1. Applicant may request a copy of the full written screening criteria in advance of paying the fee.
2. All applicants for the same unit are evaluated under the same criteria.
3. Reasonable accommodations for persons with disabilities will be considered as required by law., -

7. Fair-housing nondiscrimination notice (federal FHA + Arkansas)

Equal Housing Opportunity

We are committed to compliance with the federal Fair Housing Act and all applicable Arkansas laws. We do not discriminate on the basis of race, color, religion, sex, national origin, familial status (families with children under 18), disability, or any other protected class.

1. All questions on this application are designed to elicit only information relevant to legitimate tenancy qualifications.
2. No questions regarding protected characteristics (e.g., religion, national origin, disability status beyond reasonable accommodation needs, familial status details beyond occupants) are asked or considered.
3. If you believe you have been discriminated against, you may file a complaint with the U.S. Department of Housing and Urban Development (HUD) or the Arkansas Fair Housing Commission / appropriate state agency.

Requests for Reasonable Accommodations or Modifications
If you or a household member has a disability and needs a reasonable accommodation or modification to the application process or the premises, please notify us in writing so we may engage in the interactive process required by law., -

8. Pets / occupants / vehicles

Proposed Occupants Summary (including applicant)
[[Full list of all adults and children expected to reside, with ages/relationships]]

Pet Policy at This Property: [[No pets / Pets allowed with deposit/fee / Breed/weight restrictions / Emotional support animals handled separately]]

Vehicle / Parking Rules: [[Number of vehicles permitted, assigned vs unassigned, restrictions on commercial vehicles, inoperable vehicles, etc.]]

1. Only persons listed as occupants may reside at the premises without prior written consent.
2. Unauthorized occupants or pets may constitute a material breach.
3. Parking is limited to operable, registered vehicles in designated spaces only., -

9. Additional questions and declarations

Have you or any proposed occupant ever been evicted or asked to vacate? [[Yes / No]] If yes, explain: [[Explanation]]

Have you or any proposed occupant ever been convicted of a felony? [[Yes / No]] If yes, provide details and dates: [[Details]]

Are you or any proposed occupant a registered sex offender? [[Yes / No]] (Public records check will be performed regardless.)

Do you currently owe any prior landlord money? [[Yes / No]] Details: [[Details]]

Have you filed for bankruptcy in the last 7 years? [[Yes / No]] Chapter and discharge date if applicable: [[Details]]

Will any occupants be smokers? [[Yes / No]]

Do you or any household member require a reasonable accommodation due to disability? [[Yes / No, attach request if yes]]

1. All declarations are made under penalty of perjury as to truthfulness.
2. Material omissions or false statements are grounds for denial or lease termination.
3. The landlord reserves the right to verify all information provided., -

10. Signature and authorization

Applicant Certification

I certify under penalty of perjury that the information provided in this application is true, accurate, and complete. I understand that any false statement, omission, or misrepresentation may result in denial of the application or termination of any tenancy granted. I authorize verification of all information, including consumer reports, and release of information by employers, landlords, and others.

I have read and understand the disclosures regarding application fees, FCRA rights, and fair housing.

Primary Applicant

Full Name: [[Applicant Full Name]]

Signature: _______________________________ Date: [[Date]]

Co-Applicant (if applicable)

Full Name: [[Co-Applicant Full Name]]

Signature: _______________________________ Date: [[Date]]

Landlord / Agent Use Only

Application received: [[Date/Time]]
Fee received: $[[Amount]] via [[Method]]
Screening ordered: [[Date]]
Decision: [[Approved / Denied / Conditional]] Date: [[Decision Date]]
Adverse action notice sent (if applicable): [[Yes / No / N/A]] Date: [[Date]], -

*Template, not professional legal advice. This form is provided for informational and educational purposes only. Landlords must comply with the federal Fair Housing Act, FCRA, and all applicable Arkansas statutes and local ordinances when screening tenants and charging fees. Application fees must reflect actual costs. Consult an attorney or fair housing specialist for jurisdiction-specific requirements. Information current as of June 2026.*