All Angels Assisted Living Residential Waiting List Application.

Each individual applicant must fill out a separate application form. If Any answer doesn't apply to you, please enter "N/A". A one-time non-refundable waiting list fee of $500 will be charged per prospective resident. An additional 3.2% ($16) convenience fee will be charged to your credit or debit card. If later on, the resident is admitted to the facility, this waiting list fee of $500 will be deducted from the first monthly service fee. For a limited time only, the non-refundable fee of $500 is waived. So, please take advantage of this opportunity while it's available. Thank you for your understanding.

1. Applicant Full Name

2. Applicant Email and Telephone

3. Applicant Citizenship

4. Applicant Present Address

5. Applicant Height (Feet/Inches)

6. Applicant Weight (Pounds)

7. Applicant Eye Color

8. Applicant Hair Color

9. Applicant Birth Date

10. Applicant Age

11. Applicant Gender

12. Applicant Marital Status

14. Pets

Are you bringing any Pets (e.g. animals, reptiles, birds, fish and insects ect...)? (Pets are strictly prohibited on this facility)

15. Weapons

Are you bringing any weapons (e.g. rifles, guns, ammunitions, knives, swords ect...)? If yes, will it be in a locked container?

16. Felonies

Do you have any felony (e.g. Drug/DUI, Spousal Abuse, Manufacture/Sale/Distribution of Illegal substances, Prostitution, Crimes against people or property, Sex crimes ect...)?

17. Guarantor

Please specify which Guarantor. If there is no Guarantor, please select 'Other'

W-Guarantor

Individual

Company

Government Entity

Other

18. Guarantor Full Name

19. Guarantor Address

20. Guarantor Email and Telephone

21. Income Sources

What is your source of income? Please check all that apply to you.

W-Income Sources

Employment (Employee)

Business (Self-Employed)

Government Subsidy

Inheritance

Grant

Investments

Stocks / Mutual Funds

Pension

Lottery

Other

22. Monthly Income

What is your gross monthly income in USD?

23. Previous Offenses

Please select All that apply to you, if Any, from the following list:

W-Offenses

You smoke.

You are on Prescribed/Unprescribed drugs.

You consume/sell/ manufacture Marijuana or Methamphetamine or any other illicit drugs.

You are addicted to alcohol or drugs.

You have been previously evicted.

You have been asked to move out by a landlord. or another facility

You have breached a lease or a resident agreement.

You have surrendered any previous property to the owner in the same condition found.

You have lost any security deposits due to damages.

You have been late in paying rents, monthly service fees and other installments.

You have lost a property in a foreclosure.

You have filed for bankruptcy.

You have had any credit problems.

You have been convicted of a crime.

You have been/ are a registered sex offender.

There are criminal matters pending against you.

You have additional information you want us to consider.

Other

24. True Information

You declare that All the information contained in this application form is True to the best of your knowledge and ability. Any False or Misleading information could lead to rejection or premature discharge.

25. Consent

I agree to the enclosed All Angels Assisted Living Residential Waiting List Application Terms and Conditions

26. File Upload

Please upload your Files (Only in PDF, JPG, JPEG, PNG format) here.

(1) A copy of the applicant's valid government picture ID.

(2) A copy of the guarantor's valid government picture ID.

Accepts .pdf, .jpg, .jpeg, .png files

Size limit: 10 MB

27. Date Submitted

28. Signature

Please sign your application form.

Signature

All Angels Assisted Living Residential Waiting List Application.

Do you have or have you ever had? Please check all that apply to you

Are you bringing any Pets (e.g. animals, reptiles, birds, fish and insects ect...)? (Pets are strictly prohibited on this facility)

Are you bringing any weapons (e.g. rifles, guns, ammunitions, knives, swords ect...)? If yes, will it be in a locked container?

Do you have any felony (e.g. Drug/DUI, Spousal Abuse, Manufacture/Sale/Distribution of Illegal substances, Prostitution, Crimes against people or property, Sex crimes ect...)?

Please specify which Guarantor. If there is no Guarantor, please select 'Other'

What is your source of income? Please check all that apply to you.

What is your gross monthly income in USD?

Please select All that apply to you, if Any, from the following list:

You declare that All the information contained in this application form is True to the best of your knowledge and ability. Any False or Misleading information could lead to rejection or premature discharge.

I agree to the enclosed All Angels Assisted Living Residential Waiting List Application Terms and Conditions

Please sign your application form.