Nebraska Rental Application Template
This Nebraska Rental Application Template is designed to gather information from prospective tenants in compliance with the Nebraska Residential Landlord and Tenant Act. It is intended to be used by landlords in the State of Nebraska for the purpose of evaluating a potential tenant's eligibility.
Applicant Information
Please provide the following information:
- Full Name: ____________
- Date of Birth: ____________
- Social Security Number: ____________
- Phone Number: ____________
- Current Address: ____________
- City, State, Zip: ____________
- Driver’s License Number and State: ____________
- Email Address: ____________
Employment Information
Provide details regarding your current employment:
- Employer Name: ____________
- Employer Address: ____________
- Position/Title: ____________
- Monthly Income: ____________
- Phone Number: ____________
- Supervisor's Name: ____________
Previous Rental History
List your rental history for the past three years:
-
Most recent property
- Address: ____________
- Landlord's Name: ____________
- Landlord's Phone Number: ____________
- Date of Tenancy (from/to): ____________
- Reason for Leaving: ____________
-
Previous property
- Address: ____________
- Landlord's Name: ____________
- Landlord's Phone Number: ____________
- Date of Tenancy (from/to): ____________
- Reason for Leaving: ____________
Additional Occupants
Provide names and relationships of all additional occupants who will be living in the property:
- Name and Relationship: ____________
- Name and Relationship: ____________
- Name and Relationship: ____________
Pet Information
If applicable, describe any pets that will reside on the premises:
- Type of Pet: ____________
- Breed: ____________
- Weight: ____________
Authorization
By signing below, I authorize the verification of the information provided on this form as to my credit and employment. I understand that this information will be used to determine my eligibility for tenancy. I certify that all information provided is true and accurate to the best of my knowledge.
Signature: ____________ Date: ____________
Note: This template does not include all state-specific compliance requirements and landlords are advised to ensure that their application process complies with all applicable laws in the State of Nebraska.