J&A Inc
P.O. Box 180
Corinth, MS 38835-0180
(662) 287-6158
info@ja-inc.com
https://www.ja-inc.com
Please click here to download a printable version of the J&A, Inc - Eligibility Application and fill out manually

ELIGIBILITY APPLICATION

J & A Management would like to take this opportunity to thank you for your interest in our apartments. Listed below are the items that you will need to bring back with your completed application to be considered for occupancy. Please be aware that we do have a waiting list.
  1. Must be 21 years of age or older and/or emancipated
  2. Must be within the required income guidelines.
Please Bring the Following:
  1. $20.00 MONEY ORDER ONLY for each adult member that will be occupying the unit.
  2. Verification Documentation as follows:
    • Valid & Current ID for all adult members
    • Social Security Card for all household members
    • Birth Certificates for all minors
  3. Current verification of income from all sources (Employment, Social Security, Child Support, TANF, etc.)
At the time of application, you will be asked to sign a “Tenant Release & Consent” form. This will authorize us to verify all necessary & applicable income as well as give us permission to obtain a copy of your credit report and criminal background report. To avoid a delay in processing your application, please be sure that your application is filled out COMPLETELY & ACCURATELY. You will be notified in writing if your application is approved or denied.
Property Name
*

APPLICANT/ TENANT INFORMATION

Full Name
*
Home Phone #
*
Street Address
*
City, State and Zip
*
Other Phone #
*
Email
*
Do you Currently Rent or Own?
*
How Long?
*

HOUSEHOLD COMPOSITION

List all persons who will be living in the unit. Give the relationship of each family member to the head of household. If this eligibility application is being completed by an applicant who is applying for occupancy with an existing household, only include the information for the new applicant.

Each household member age 18 years or older and under age 18 if head, spouse, or co-head of household must disclose income and assets and sign and date this application.
Household Member Name
*
Relationship to Applicant
*
Date of Birth
*
Current Marital Status
*
Date of divorce/separation
*
Will this person be a student during this and/or the upcoming calendar year?
*
* Include public and private elementary, junior & senior high, college, university, technical, trade, and mechanical schools. Do not include on-the-job training courses.
Part Time or Full Time?
*
Social Security Number
*
Do all of the above household members reside in the household 100% of the time?
*
Please list the household members that do not live in the household 100% of the time
*
Anticipated changes in the household size within the next 12 months?
*
Please explain
*
Anticipated change in number of students within the next 12 months?
*
Please explain
*
Is EVERY household member listed above a full-time (FT) student?
*

HOUSEHOLD INCOME INFORMATION

List current and anticipated income for the twelve-month period beginning on the anticipated move-in date or effective date of recertification. 
Include all full time, part time or seasonal income even if completing this application in the off-season.

DO YOU RECEIVE OR EXPECT TO RECEIVE
(Check YES or NO to each item, as applicable, and include gross monthly amount)

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*

Gross Monthly Amount
*
19. Other (list)
*
Gross Monthly Amount
*
20. Other (list)
*
Gross Monthly Amount
*

HOUSEHOLD ASSET INFORMATION

DOES ANY HOUSEHOLD MEMBER (INCLUDING CHILDREN) HAVE MONEY HELD IN:

Current Balance
*
(6 month average balance)

Current Balance
*

Current Balance
*

Current Balance
*

Current Balance
*

Current Balance
*

Current Balance
*

Include Trusts, 401K, etc., only if the accounts are accessible to the household prior to termination of employment, retirement, or death. If you are unsure, list the account and it will be verified.
Current Balance
*

Current Balance
*

Current Balance
*

*Include Trusts, 401K, etc., only if the accounts are accessible to the household prior to termination of employment, retirement, or death. If you are unsure, list the account and it will be verified.
Current Balance
*

Current Balance
*

Current Balance
*

Current Balance
*

Current Balance
*

Current Balance
*

Current Balance
*

Current Balance
*

Which account and with whom?
*
40. Other
*

Value
*
list address(es):
*

Value
*

Value
*

List person and asset(s)
*

If yes, 3rd party verification of assets is required

EMPLOYMENT INFORMATION

Current Employer Name
*
Title
*
Address
*
City, State and Zip
*
Date of Hire
*
Monthly Gross Wage
*
Supervisor
*
Phone
*
Fax
*
Previous Employment
*
Title
*
Address
*
City, State and Zip
*
Phone
*
Fax
*
From
*
To
*

SECTION 18A: RECURRING GIFTS/CASH CONTRIBUTIONS

From QUESTION 18 above, provide contact information for all ALL PERSONS outside the household that is contributing. (If a household member has more than one person contributing, use a separate line for each outside person.)
Item Number
*
Household Member
*
Name and mailing address of person contributing
*
Contact Name & phone/fax number
*
Please attach documentation available to verify the contribution (i.e., signed/notarized statement, etc.).
*
I/We hereby certify that I/we

sold or given away any assets for less than Fair Market Value during the two year (24 month) period preceding the date of this application. Any assets sold or disposed of for less than Fair Market Value must be identified below.
Household Member
*
Asset & Estimated Market Value
*
Date sold/disposed
*
Amount Received
*

MISCELLANEOUS

The following questions pertain to yourself and every member of your household who will occupy the unit. 
Check either YES or NO in response to each question. Add an explanation below for all items checked YES.

Explanation
*

Explanation
*

Name(s)
*
Explanation
*

Indicate from what source (Section 8, Rural Development RA, etc.)
*
Explanation
*

Explanation
*

EMERGENCY CONTACT

Emergency Contact Name
*
Relationship
*
Address
*
City, State and Zip
*
Cell/Home Phone
*
Home/Work Phone
*

SIGNATURES

I/we hereby affirm that the foregoing information is true and complete to the best of my/our knowledge, and authorize the Landlord to make inquiries to verify the statements herein. I/we further understand that any intentional misrepresentation in this application might result in a default in the rental agreement and/or eviction of this household. If any of the aforementioned information changes, I/we agree to notify Landlord immediately.
Applicant/Resident Signature
*
Date
*
This applicant/resident required assistance in completing the eligibility application due to:
*
Assistance in completing this application was provided by:
*
Date
*

Residential History for the past 3 Years:

Address
*
Landlord
*
Phone No
*
Length of Residency (years)
*
(months)
*
If you are disabled or handicapped, you may receive a $400 deduction and /or a handicapped accessible unit under Rural Development Guidelines.

If you have indicated your desire to request this adjustment, then we will need only sufficient information (Documentation) to confirm your qualification for this status. Failure to provide this information may result in the denial of these deductions.

THIS SECTION TO BE COMPLETED ONLY BY ELDERLY FAMILIES AND/OR HANDICAPPED PERSONS

(Proof of all expenses will be required by the submitting of a copy of the expenses paid for your file.)
MEDICAL- (Includes drug, physicians, hospital charges, etc. paid out of pocket)
*
HEALTH INSURANCE
*
HANDICAP EQUIPMENT / CARE
*
CARETAKER
*
OTHER
*
I / We certify that this unit will serve as my/our primary residence, and I/we WILL NOT maintain a separate subsidized rental unit in a different location. I further certify that I am a U.S. citizen or a qualified alien.
Signature of Applicant
*
Date
*
Signature of Co-applicant
Date
I certify that all foregoing information is true and complete to the best of my knowledge. I authorize inquiries to be made to verify the statement of this application.
Signature of Applicant
*
Date
*
Co-Applicant Signature
Date
The information regarding race, national origin, and sex designation solicited on the application is requested to assure the Federal Government, acting through Rural Development that Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age, and disability are complied with. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it. The owner is required to note the race, ethnicity, and sex of individual applicants on the basis of visual observation or surname.
If you do not wish to furnish the below information, please initial
*
Applicant Information
SEX
Race / National Origin of Tenant
Ethnicity
Equal Housing Opportunity
This institution is an equal opportunity provider.
Handicap Accessible