Virginia Rental Application

Virginia-compliant rental application form under the Virginia Residential Landlord and Tenant Act (VRLTA, Va. Code § 55.1-1200 et seq.). Provide the property details, screening criteria, and fee information, and receive a complete, ready-to-use application that collects applicant personal/contact/residency history, employment and income, rental history with landlord references, pets/occupants/vehicles, FCRA-compliant consent for background and credit screening, objective screening criteria, full fee disclosure per Va. Code § 55.1-1203 (application fee capped at $50 + actual third-party out-of-pocket expenses; $32 cap for certain HUD-regulated units), fair housing notices, and signature/authorization blocks.

Application fees are permitted up to the statutory maximums and must be nonrefundable only to the extent of actual screening costs. Any excess or if applicant is rejected or withdraws must be handled per statute (itemized accounting and refund of unused portion within 20 days in most cases).

This form follows fair housing rules (federal FHA + Virginia law) and HUD guidance on criminal history screening: use individualized assessment, not blanket bans.

This is a template for screening only. It is not a lease. All information is provided by the applicant under penalty of perjury where noted. Landlord should verify all information independently and consult counsel for specific situations., -

Property and Tenancy Details

Property Address: [[Property Full Address Including Unit Number if Applicable]], [[City]], Virginia [[ZIP Code]]

Landlord / Property Manager: [[Landlord or Property Management Company Full Legal Name]]

Contact for Application: [[Landlord Phone Number]] | [[Landlord Email Address]]

Monthly Rent: $[[Monthly Rent Amount]]

Security Deposit: $[[Security Deposit Amount]]

Lease Type: [[Fixed Term / Month-to-Month]]

Proposed Lease Start Date: [[Lease Start Date]]

Application Fee Amount: $[[Application Fee Amount]] (max $50 + documented third-party costs per Va. Code § 55.1-1203; $32 cap for certain HUD units)

Application Fee covers: [[Describe e.g. credit report, background check, or "actual out-of-pocket expenses only"]]

Is this a HUD-regulated / public housing unit? [[Yes / No]]

Application Submission Deadline: [[Application Deadline Date]], -

Applicant Information, Primary Applicant

Full Legal Name: [[Applicant Full Legal Name]]

Date of Birth (MM/DD/YYYY): [[Applicant Date of Birth]]

Social Security Number (last 4 digits or full if required for screening): [[SSN Last 4 or Full for FCRA Purposes]]

Government-Issued Photo ID (type and number): [[Driver's Licence / Passport / Other ID Type and Number]]

Current Phone Number: [[Applicant Primary Phone]]

Current Email Address: [[Applicant Email]]

Current Residential Address: [[Current Address]], [[City]], [[State]] [[ZIP Code]]

Length of Time at Current Address: [[Months/Years at Current]]

Reason for Leaving Current Residence: [[Reason for Leaving]]

Current Monthly Rent or Housing Cost: $[[Current Monthly Housing Cost]]

Current Landlord / Property Manager Name: [[Current Landlord Name]]

Current Landlord Phone: [[Current Landlord Phone]]

Current Landlord Email: [[Current Landlord Email]], -

Previous Residences (Last 3 Years, Provide at Least Two)

Previous Residence 1

Address: [[Previous Address 1]], [[City]], [[State]] [[ZIP Code]]

Dates of Tenancy: [[Start Date 1]] to [[End Date 1]]

Monthly Rent Paid: $[[Rent Amount 1]]

Landlord / Property Manager Name: [[Previous Landlord 1 Name]]

Landlord Phone: [[Previous Landlord 1 Phone]]

Landlord Email: [[Previous Landlord 1 Email]]

Reason for Leaving: [[Reason for Leaving 1]]

Previous Residence 2

Address: [[Previous Address 2]], [[City]], [[State]] [[ZIP Code]]

Dates of Tenancy: [[Start Date 2]] to [[End Date 2]]

Monthly Rent Paid: $[[Rent Amount 2]]

Landlord / Property Manager Name: [[Previous Landlord 2 Name]]

Landlord Phone: [[Previous Landlord 2 Phone]]

Landlord Email: [[Previous Landlord 2 Email]]

Reason for Leaving: [[Reason for Leaving 2]]

Previous Residence 3 (if applicable)

Address: [[Previous Address 3]], [[City]], [[State]] [[ZIP Code]]

Dates of Tenancy: [[Start Date 3]] to [[End Date 3]]

Monthly Rent Paid: $[[Rent Amount 3]]

Landlord / Property Manager Name: [[Previous Landlord 3 Name]]

Landlord Phone: [[Previous Landlord 3 Phone]]

Landlord Email: [[Previous Landlord 3 Email]]

Reason for Leaving: [[Reason for Leaving 3]], -

Co-Applicants and All Proposed Adult Occupants

List every adult (18+) who will reside at the premises. Each adult applicant should complete relevant sections or sign below.

Co-Applicant / Occupant 1 Full Name: [[Co-Applicant 1 Full Name]], Relationship to Primary: [[Relationship]], DOB: [[DOB]], Phone: [[Phone]], Email: [[Email]]

Co-Applicant / Occupant 2 Full Name: [[Co-Applicant 2 Full Name]], Relationship to Primary: [[Relationship]], DOB: [[DOB]], Phone: [[Phone]], Email: [[Email]]

Additional Adult Occupants (if more): [[List Additional Adult Names, DOBs, Phones, Emails and Relationships]], -

All Proposed Occupants (Including Minors)

Total Number of Occupants: [[Total Number]]

Full List of All Persons Who Will Reside at the Premises (include ages for minors):

• [[Occupant Full Name 1]], Age [[Age]], Relationship [[Relationship]]

• [[Occupant Full Name 2]], Age [[Age]], Relationship [[Relationship]]

• [[Occupant Full Name 3]], Age [[Age]], Relationship [[Relationship]]

• [[Additional Occupants as Needed]], -

Pets

Will any pets reside at the premises? [[Yes / No]]

If yes, provide details for each:

• Type/Breed: [[Pet Type 1]], Age: [[Age]], Weight: [[Weight]], Number: [[Count]]

• Type/Breed: [[Pet Type 2]], Age: [[Age]], Weight: [[Weight]], Number: [[Count]]

Service or support animals (if any, protected under Fair Housing Act): [[Description or "None"]], -

Vehicles and Parking

Number of Vehicles to be Parked: [[Number of Vehicles]]

Vehicle 1: Make/Model/Year [[Vehicle 1 Details]], Licence Plate [[Plate 1]], State [[State]]

Vehicle 2: Make/Model/Year [[Vehicle 2 Details]], Licence Plate [[Plate 2]], State [[State]]

Parking Requirements / Requests: [[Assigned Parking, Visitor, EV Charging, Storage, or Other Requests]], -

Employment and Income Verification

Income information is requested solely to assess the applicant's ability to pay rent and will be considered together with credit history, rental history, and references. Per fair housing guidance, income requirements must be applied consistently and not used as a pretext for discrimination.

Current Employment, Primary Applicant

Current Employer / Company: [[Current Employer Name]]

Position / Title: [[Job Title]]

Length of Employment: [[Years/Months]]

Gross Monthly Income (before deductions): $[[Gross Monthly Income]]

Pay Frequency: [[Weekly / Bi-weekly / Semi-monthly / Monthly]]

Employer Address: [[Employer Address]]

Supervisor / HR Contact Name: [[Supervisor Name]]

Supervisor Phone: [[Supervisor Phone]]

Supervisor Email: [[Supervisor Email]]

Previous Employment (if current < 2 years)

Previous Employer: [[Previous Employer]]

Position: [[Previous Title]]

Dates: [[Dates]]

Gross Monthly Income: $[[Amount]]

Other Income Sources (if any)

Source and Monthly Amount: [[Other Income Source e.g. Pension, Support, Investments]], $[[Monthly Amount]]

Employment, Co-Applicant (if applicable)

Employer: [[Co-Applicant Employer]], Position: [[Title]], Gross Monthly: $[[Income]], Length: [[Length]], -

Rental History Summary and References

(Previous landlord contacts already listed above.)

Personal or Professional Reference 1:

Name: [[Reference 1 Full Name]]

Relationship: [[Relationship]]

Phone: [[Phone]]

Email: [[Email]]

Personal or Professional Reference 2:

Name: [[Reference 2 Full Name]]

Relationship: [[Relationship]]

Phone: [[Phone]]

Email: [[Email]], -

Background and Credit Check Consent (FCRA Disclosure)

I/We authorize the Landlord or its agents to obtain consumer reports, credit reports, criminal background reports, eviction records, and other information from third parties for the purpose of evaluating this rental application. This authorization is made pursuant to the Fair Credit Reporting Act (FCRA). I/We understand that a consumer report may be obtained and that I/We have the right to request the name and address of the consumer reporting agency and to obtain a copy of the report.

Applicant Signature / Acknowledgment for FCRA: [[Applicant Signature]] Date: [[Date]], -

Application / Screening Fee Disclosure and Agreement (Va. Code § 55.1-1203)

Application Fee: $[[Application Fee Amount]] (capped at $50 exclusive of actual documented out-of-pocket third-party costs for background, credit, or pre-occupancy checks. HUD-regulated units: $32 cap exclusive of such costs).

Fee is non-refundable to the extent it covers actual screening costs incurred. If the applicant is not approved or withdraws, Landlord will provide an itemized accounting of costs deducted and refund any excess within 20 days (or as required by law).

Additional refundable application deposit (if any): $[[Application Deposit Amount or 0]]

By signing, Applicant acknowledges receipt of this fee disclosure., -

Screening Criteria (Objective and Consistently Applied)

Landlord applies the following objective criteria to all applicants. Denial or conditions will be based on individualized assessment consistent with HUD guidance on criminal records and fair housing laws.

• Income: Minimum gross monthly income of [[e.g. 3x]] monthly rent (or as disclosed).

• Credit: Minimum credit score [[e.g. 620]] or alternative evidence of responsible financial history. (Domestic/family abuse victims: evidence of status will be considered to mitigate low credit scores per Va. Code § 55.1-1203.)

• Rental History: No evictions within [[e.g. 5 years]] or patterns of late payment or lease violations.

• Criminal Background: Case-by-case review; no automatic disqualification for arrest records or convictions without individualized assessment of nature, recency, and relevance to tenancy safety/property risk.

• Other: [[Any additional objective criteria, e.g. positive references, no pets policy exceptions]], -

Fair Housing Nondiscrimination Notice

This property is operated in compliance with the federal Fair Housing Act and Virginia fair housing laws. We do not discriminate on the basis of race, color, religion, national origin, sex, familial status, disability, or any other protected class under applicable law (including sexual orientation and gender identity protections where applicable in Virginia).

We provide reasonable accommodations and modifications for persons with disabilities upon request.

Complaints may be filed with HUD or the Virginia Fair Housing Office., -

Pets, Occupants, and Vehicles Acknowledgment

Applicant certifies that the information provided about occupants, pets, and vehicles is accurate. Landlord's approval of this application is subject to verification and any pet or occupancy policies disclosed separately., -

Signature and Authorization

By signing below, I/We certify that all information provided in this application is true and complete to the best of my/our knowledge. I/We understand that any false statement may result in denial of the application or termination of tenancy. I/We authorize verification of all information provided herein, including contacting references, employers, and prior landlords, and obtaining consumer reports as described.

Primary Applicant Signature: _______________________________ Date: [[Date]]

Printed Name: [[Applicant Full Legal Name]]

Co-Applicant / Additional Adult Signature (if applicable): _______________________________ Date: [[Date]]

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

Landlord / Agent Acknowledgment of Receipt: _______________________________ Date: [[Date]], -

Sources / Law references (as of June 2026): Va. Code § 55.1-1203 (application fees and deposits); VRLTA Va. Code Title 55.1 Chapter 12; Fair Credit Reporting Act (15 U.S.C. § 1681 et seq.); Fair Housing Act (42 U.S.C. § 3601 et seq.); HUD guidance on criminal screening; Virginia fair housing protections. This template is for informational and screening purposes only and is not legal advice. Verify with current official sources and consult a licensed attorney for jurisdiction-specific compliance. Application fees and screening practices should be confirmed against the latest statutes and local ordinances.