New Jersey Residential Rental Application and Screening Packet

New Jersey Residential Rental Application and Screening Packet

Use one packet per adult applicant. New Jersey generally bars criminal-record inquiries until after a conditional offer.

Privacy rule: Do not place sensitive identifiers or financial-account numbers in this packet. Collect identity credentials only through a separately approved secure channel with access controls and a retention schedule.

New Jersey Fair-Chance Screening Module

Before accepting an application fee, disclose in writing:

• Criminal history is included in the housing provider's eligibility criteria: ☐ Yes ☐ No
• The applicant may provide evidence of record inaccuracies, rehabilitation, or mitigating factors: ☐ Acknowledged

Before a conditional offer, do not ask orally or in writing about criminal records, except for the Act's narrow federally assisted-housing methamphetamine-production conviction and lifetime sex-offender-registration exceptions. Do not include criminal-history questions in the initial application.

After a conditional offer, use a separately reviewed process. Do not evaluate arrests or charges without conviction, expunged or sealed records, convictions on appeal, vacated or legally nullified convictions, juvenile adjudications, or out-of-state conduct that would not be an indictable offense in New Jersey. N.J.S.A. §§ 46:8-52 to 46:8-64.

• Conditional offer issued: [__/__/____]
• Separate post-offer disclosure/assessment used: ☐ Yes ☐ Not applicable
• Applicant evidence received and reviewed: [________________________________]

1. Property and Housing Provider

• Property address/unit: [________________________________]
• Monthly rent/proposed move-in/term: [________________________________]
• Housing provider/agent and notice address: [________________________________]
• Completed application received: [__/__/____] at [____] ☐ a.m. ☐ p.m.

2. Written Screening Criteria

Apply criteria consistently. Do not discriminate because of race, color, religion, sex, disability, familial status, or national origin. 42 U.S.C. § 3604. Check additional New Jersey and local protected classes.

3. Applicant Information

• Full legal name/name used for references: [________________________________]
• Email/telephone: [________________________________]
• Current address and time there: [________________________________]
• Requested move-in date: [__/__/____]
• Other proposed occupants/relationship: [________________________________]
• Animals: [________________________________]
• Confidential assistance-animal process requested: ☐ Yes ☐ No

Do not request criminal-history information in this initial application.

4. Residence and Income History

5. Applicant Statements and Consumer-Report Authorization

• ☐ Information is complete and accurate to the best of the applicant's knowledge.
• ☐ Applicant received criteria and fair-chance disclosure before any fee.
• ☐ Applicant received the privacy/retention notice.
• ☐ Applicant understands this is not a lease or promise of approval.

I give written instructions authorizing [HOUSING PROVIDER/AGENT] and [CONSUMER REPORTING AGENCY] to obtain and use the checked non-criminal reports solely for this rental application and lawful account review. A criminal report may be requested only through a lawful post-conditional-offer process. 15 U.S.C. § 1681b(a)(2).

• Agency/address/telephone: [________________________________]
• Initial reports: ☐ Credit ☐ Rental history ☐ Eviction records ☐ Other: [________]
• Authorization expires: [__/__/____]

Applicant signature: [________________________________] Date: [__/__/____]

6. Fee Receipt and Decision Record

• Amount/character: $[________] ☐ No fee ☐ Application fee ☐ Refundable deposit
• Fair-chance fee disclosure delivered first: ☐ Yes
• Criteria applied exactly as disclosed: ☐ Yes
• Decision: ☐ Approved ☐ Conditional offer ☐ Denied on non-criminal criteria ☐ Withdrawn
• Criterion and verified fact: [________________________________]
• Consumer report affected decision: ☐ Yes ☐ No
• Decision maker/date: [________________________________]

7. Adverse-Action Notice

Applicant/property/date: [________________________________]

Action and specific reason: [________________________________]

If a consumer report affected the action, identify the agency, address, telephone, score and required score factors if used. The agency did not make the decision. The applicant may request a free report within 60 days and dispute inaccurate or incomplete information. 15 U.S.C. § 1681m(a). Use a separately reviewed Fair Chance in Housing Act notice for any post-offer criminal-history withdrawal.

Housing provider/agent signature: [________________________________]

Sources and References

• 15 U.S.C. § 1681b — https://uscode.house.gov/view.xhtml?req=(title:15%20section:1681b%20edition:prelim)
• 15 U.S.C. § 1681m — https://uscode.house.gov/view.xhtml?req=(title:15%20section:1681m%20edition:prelim)
• 42 U.S.C. § 3604 — https://uscode.house.gov/view.xhtml?req=(title:42%20section:3604%20edition:prelim)
• New Jersey Fair Chance in Housing Act, P.L. 2021, c. 110 — https://pub.njleg.state.nj.us/Bills/2020/AL21/110_.PDF