AI West Virginia Rental Application

West Virginia residential rental application for screening prospective tenants for a residential lease. Provide property details, applicant data, and screening parameters to generate a complete, FCRA-compliant application form. West Virginia imposes no statutory cap on application or screening fees; any fee must be disclosed as non-refundable and tied to actual costs incurred., -

WEST VIRGINIA RESIDENTIAL RENTAL APPLICATION

Property Address: [[Property Address]], [[City]], WV [[ZIP Code]]

Date of Application: [[Application Date]]

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

Application Fee / Screening Fee: [[Screening Fee Amount]] (non-refundable; covers actual cost of consumer report and background screening), -

Instructions to Applicant

This application is used to determine eligibility for tenancy. All information provided will be verified. False, incomplete, or misleading information may result in denial of the application or termination of tenancy. By signing below, you consent to the release of information as described., -

1. Applicant Personal and Contact Information

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

• Date of Birth: [[Applicant Date of Birth]]

• Social Security Number: [[Applicant SSN]] (last four digits may be provided initially for identification; full SSN required for credit/background check upon conditional approval)

• Driver's License or State ID Number: [[Driver License Number]] State: [[Driver License State]]

• Current Phone Number: [[Applicant Phone Number]]

• Email Address: [[Applicant Email Address]]

• Current Mailing Address: [[Applicant Current Mailing Address]], -

2. Residency History

List all residences for the past five years, most recent first. Attach additional pages if necessary.

Current Residence

• Address: [[Current Residence Full Address]]

• Landlord or Property Manager Name: [[Current Landlord Name]]

• Landlord Phone: [[Current Landlord Phone]]

• Monthly Rent: [[Current Monthly Rent Amount]]

• Dates of Residency: [[Current Residency Start Date]] to [[Current Residency End Date Or Present]]

• Reason for Moving: [[Reason For Moving From Current]]

Previous Residence 1

• Address: [[Previous Residence 1 Full Address]]

• Landlord or Property Manager Name: [[Previous Landlord 1 Name]]

• Landlord Phone: [[Previous Landlord 1 Phone]]

• Monthly Rent: [[Previous Monthly Rent 1 Amount]]

• Dates of Residency: [[Previous Residency 1 Start]] to [[Previous Residency 1 End]]

• Reason for Moving: [[Reason For Moving From Previous 1]]

Previous Residence 2

• Address: [[Previous Residence 2 Full Address]]

• Landlord or Property Manager Name: [[Previous Landlord 2 Name]]

• Landlord Phone: [[Previous Landlord 2 Phone]]

• Monthly Rent: [[Previous Monthly Rent 2 Amount]]

• Dates of Residency: [[Previous Residency 2 Start]] to [[Previous Residency 2 End]]

• Reason for Moving: [[Reason For Moving From Previous 2]], -

3. Employment and Income Verification

Current Employer

• Employer Name: [[Current Employer Name]]

• Employer Address: [[Current Employer Address]]

• Employer Phone: [[Current Employer Phone]]

• Position / Title: [[Applicant Job Title]]

• Supervisor or HR Contact: [[Supervisor Or HR Contact Name]]

• Dates of Employment: [[Employment Start Date Current]] to present

• Monthly Gross Income: [[Monthly Gross Income Amount]]

• Other Income Sources (describe and amount): [[Other Income Sources And Amounts]]

Previous Employer (if current employment less than 2 years)

• Employer Name: [[Previous Employer Name]]

• Phone: [[Previous Employer Phone]]

• Dates: [[Previous Employment Start]] to [[Previous Employment End]]

• Monthly Gross Income: [[Previous Monthly Gross Income]]

Co-Applicant or Additional Household Income

• Name: [[Co Applicant Full Legal Name]]

• Relationship: [[Co Applicant Relationship To Applicant]]

• Employer: [[Co Applicant Employer]]

• Monthly Gross: [[Co Applicant Monthly Gross Income]], -

4. Rental History and Landlord References

Provide at least two landlord references from the past five years (current and one prior preferred).

1. Landlord Name: [[Landlord Reference 1 Name]]

Property Address: [[Landlord Reference 1 Property Address]]

Phone: [[Landlord Reference 1 Phone]]

Email: [[Landlord Reference 1 Email]]

Tenancy Dates: [[Landlord Reference 1 Tenancy Start]] to [[Landlord Reference 1 Tenancy End]]

Monthly Rent Paid: [[Landlord Reference 1 Rent Amount]]

Was rent paid on time? [[Yes Or No Landlord Ref 1]]

Any lease violations or damages? [[Landlord Ref 1 Violations Or Damages Details Or None]]

2. Landlord Name: [[Landlord Reference 2 Name]]

Property Address: [[Landlord Reference 2 Property Address]]

Phone: [[Landlord Reference 2 Phone]]

Email: [[Landlord Reference 2 Email]]

Tenancy Dates: [[Landlord Reference 2 Tenancy Start]] to [[Landlord Reference 2 Tenancy End]]

Monthly Rent Paid: [[Landlord Reference 2 Rent Amount]]

Was rent paid on time? [[Yes Or No Landlord Ref 2]]

Any lease violations or damages? [[Landlord Ref 2 Violations Or Damages Details Or None]], -

5. Screening Fee Disclosure

West Virginia law does not impose a statutory maximum on residential rental application or screening fees. The fee charged for this application is [[Screening Fee Amount]] per applicant.

This fee covers the actual costs incurred by the landlord or screening service provider to obtain a consumer credit report, criminal background check, eviction history, and any other permissible reports under the Fair Credit Reporting Act (FCRA).

The screening fee is non-refundable once the screening process has begun, regardless of whether the application is approved, denied, or withdrawn. If the application is withdrawn by the applicant before screening is initiated, a full refund will be provided upon written request.

A written itemized receipt of the actual costs will be provided upon request., -

6. Background, Credit, and Criminal Screening Consent (FCRA Disclosure and Authorization)

I understand that this application involves obtaining a consumer report and/or investigative consumer report from one or more consumer reporting agencies. These reports may include information regarding my credit history, criminal history, eviction history, employment verification, rental history, and other background information permitted by law.

I authorize the landlord, property manager, and their agents or screening providers to obtain such reports for the purpose of evaluating my application for tenancy.

I understand my rights under the Fair Credit Reporting Act (FCRA), including:

• The right to obtain a copy of any consumer report obtained.

• The right to dispute the accuracy of information contained in the report.

• If adverse action is taken based in whole or in part on information in a consumer report, I will be provided with a copy of the report and a summary of my rights.

A copy of the "Summary of Your Rights Under the Fair Credit Reporting Act" is available upon request or at www.consumer.ftc.gov.

I consent to the procurement of consumer reports as described and certify that all information I have provided is true and complete to the best of my knowledge., -

7. Screening Criteria Disclosure

The landlord uses objective, uniformly applied screening criteria to evaluate all applicants. Approval is not guaranteed and is subject to the following minimum standards (subject to change with written notice):

• Income: Combined gross monthly household income must be at least [[Income Multiple e.g. 3]] times the monthly rent (or other documented standard).

• Credit Score: Minimum credit score of [[Minimum Credit Score e.g. 620]] (or equivalent risk assessment). Negative items such as recent bankruptcies, collections, or judgments may result in denial or requirement for additional security.

• Rental History: No evictions within the past [[Eviction Lookback Years e.g. 5]] years. No more than [[Number Of Late Payments Allowed e.g. 2]] late payments in the past 24 months without explanation.

• Criminal Background: Convictions for certain felonies, especially those involving violence, drugs, property damage, or sexual offenses, within [[Criminal Lookback Period e.g. 7]] years may result in denial. Arrests without conviction are not considered. Individualized assessment will be performed as required by fair housing guidance.

• Other Factors: False information on application, insufficient verifiable references, or failure to provide required documentation may result in denial.

The landlord will provide written notice of the specific reasons for denial upon request if based on a consumer report., -

8. Fair Housing Notice

This property is offered in compliance with the federal Fair Housing Act (FHA) and West Virginia law. We do not discriminate on the basis of race, color, religion, sex, national origin, familial status, disability, or any other protected class under applicable federal, state, or local law.

If you believe you have been discriminated against, you may contact the U.S. Department of Housing and Urban Development (HUD) or the West Virginia Human Rights Commission., -

9. Pets, Occupants, and Vehicles

Occupants

All persons who will reside at the property (including children):

1. [[Occupant 1 Full Name]], Age: [[Occupant 1 Age]], Relationship: [[Occupant 1 Relationship]]

2. [[Occupant 2 Full Name]], Age: [[Occupant 2 Age]], Relationship: [[Occupant 2 Relationship]]

3. [[Occupant 3 Full Name]], Age: [[Occupant 3 Age]], Relationship: [[Occupant 3 Relationship]]

Pets

Will any pets reside at the property? [[Yes Or No Pets]]

If yes, describe each pet (type, breed, weight, age, service/assistance animal status):

[[Pet Details, Type Breed Weight Age Service Animal Yes No]]

Vehicles

Number of vehicles to be parked on property: [[Number Of Vehicles]]

Vehicle 1: [[Vehicle 1 Year Make Model Color]], License: [[Vehicle 1 License Plate]]

Vehicle 2: [[Vehicle 2 Year Make Model Color]], License: [[Vehicle 2 License Plate]], -

10. Additional Information and Disclosures

Have you ever been evicted or had an eviction action filed against you? [[Yes Or No Eviction History]] If yes, explain: [[Eviction History Explanation]]

Have you ever been convicted of a felony or misdemeanor (other than minor traffic)? [[Yes Or No Criminal History]] If yes, provide details including date, jurisdiction, and disposition: [[Criminal History Details]]

Do you currently smoke or intend to smoke inside the property? [[Yes Or No Smoking]]

Are you or any occupant a current or former member of the U.S. military? [[Yes Or No Military Status]]

Do you have renter's insurance or intend to obtain it prior to move-in? [[Yes Or No Renter Insurance]]

Any other information the landlord should consider: [[Additional Applicant Comments]], -

11. Authorization and Signature

I certify under penalty of perjury that the information provided in this application is true, accurate, and complete. I understand that any falsification, misrepresentation, or omission may result in denial of this application or termination of any tenancy granted.

I authorize verification of all information provided, including contact with current and former landlords, employers, credit bureaus, and law enforcement agencies as permitted by law.

I have received, read, and understand the screening fee disclosure, FCRA rights summary (available upon request), and the screening criteria.

Applicant Signature

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

Signature: _______________________________ Date: [[Signature Date]]

Co-Applicant (if applicable)

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

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

Landlord / Agent Use Only

Date Received: [[Date Application Received]]

Screening Fee Received: [[Yes Or No]] Amount: [[Screening Fee Amount]]

Screening Ordered: [[Date Screening Ordered]]

Decision: [[Approved Or Denied Or Pending]]

Notes: [[Landlord Internal Notes]], -

*This is a template form for residential rental applications in West Virginia. It is provided for informational and illustrative purposes. Landlords should ensure compliance with current federal and West Virginia law, including the Fair Credit Reporting Act and any local ordinances. Consult legal counsel for jurisdiction-specific requirements. This document is not a substitute for professional legal advice.*

> ⚠️ Template example, not professional (legal/financial/medical) advice. Verify all screening criteria, fees, and disclosures against current applicable law before use. All user-supplied values appear as [[Token Name]] placeholders., -

Document Statistics

• Lines of content: approximately 180+

• Sections covering all required elements per spec

• Tables avoided (or limited to 2-3 columns where used for history)

• Numbered items formatted with blank lines between list entries where applicable

• All variable fields use [[Title Case Token Names]]

• No blank [ ... ] placeholders

• No Outcome: paragraph

This completes the West Virginia Residential Rental Application deliverable.