Career Connextions

*Name:		Occupation:
*Address:		Firm Name:
*City:		Firm Street:
*State:	*Zip:	City:
*Email:		State:	Zip:

How long at current address:	Years	Months	How Long:
			How Long:
Previous addresses: (Need 5 yr history)			Work Hours:
*Home Phone:			Work Telephone
Other Phone:			Travel with work?
Best time to reach you at home:	AM PM

Sex:	MF	Age:			If Student, what school do you go to?
Birthday: (mm/dd/yy)					What did/do you study?

Do you smoke?	NoLight Heavy	Any children living with you?		Yes No		How Many?
Marital Status:	M S D Separated Widow	Age:	Sex:		Age:		Sex:
		Age:	Sex:		Age:		Sex:

Hobbies		If you want to move in with someone please check items below you desire:
Do you have pets?	Y N	Apt	Jacuzzi
How Many?		Condo	Near Bus
Dog Cat Other		Fireplace	Near the Beach
Sex of Pet(s):	M F	Gated	On the Beach
Sex of Pet(s):	M F	Gym	Pool
		High Rise	Tennis Courts
		House

If you have a place to share with someone, please check items below:

Rent Range

From $

To $

	Own	Rent	Furn	Unfurn
Apartment
Condo
Duplex
House
Townhouse

Areas Preferred:

1st Choice:

2nd Choice:

3rd Choice:

Will you look together for a place?

Y N

Number of bedrooms:

Number of Baths:

Furniture Needed:

Furniture Owned:

Bedroom(s):

	Yes/No		Yes/No
Air Cond.		Near Beach
Dishwasher		Near Bus
Dryer		On Beach
Garage		Poof
Gated		Tennis Courts
Gym		Washer
High Rise		Yard
Jacuzzi

Dinning Room:

Kitchen:

Living Room:

Entire House:

Other

None

Section of town you live in:

Place to store items?

Can you store?

Y N

Nearest cross street?

THE FOLLOWING QUESTIONS APPLY TO THE TYPE OF
PERSON YOU DESIRE AS A ROOMMATE

Age Range:	Y N	M F Either		Two Roomates ok?	Y N
Couple ok?	Y N	Parent & Child ok?	Y N	Parent & Teenager ok?	Y N
Student ok?	Y N	Other
Pet ok?	Y N	If yes, what kind?
2 + pets ok?	Y N	Smoker ok?	Y N

Do you want a roommate for financial reasons?		Y N	Compatibility?	Y N
What do you NOT want in a roommate?
Other?

If your need is urgent for financial reasons, would you like a temporary person while we continue to look for a permanent roommate?			Y N Maybe

REFERENCES

	Name
Roommate Reference:		Home Phone:
		Work Phone:

Current Landlord:		Phone:
Previous Landlord:		Phone:

Current Work:		Work Phone:
Previous Work:		Work Phone:

Personal Reference:		Home Phone:
		Work Phone:

Personal Reference:		Home Phone:
		Work Phone:

AGREEMENT

I, the undersigned, also known as the client, agree to use Roommate Specialists for the following purposes only:
As to the landlord in confirming tenant:
To provide me with introductions to persons who desire to share living facilities and expenses with another person and to make all reasonable efforts to verify references as to employment, character, compatibility as a roommate, and checking credit references per a credit reporting service for a fee of $5 dollars. Roommate Specialists will provide such service for an initial period of 2 months for a non-refundable fee of $55 + $5 (credit report) or total of $60 which is payable in advance. If for any reason I am not completely satisfied with my original roommate or Irving situation from Roommate Specialists within 1 month of the said arrangement. Roommate Specialists will guarantee 1-month additional service at no extra charge. Roommate Specialists requires verification in form of a letter, stipulating
reason(s) for leaving and signatures of all applicable parties.

If for any reason I choose to discontinue my service before the initial 2-month period has expired, I will not be allowed a refund. The only way to receive my initial $55 fee (not including credit report fee $5) is to cancel said agreement with Roommate Specialists within the first 3 days of signing this contract. A letter, signed by the client above regarding discontinuation of agreement must be received by one of Roommate Specialist's Representatives within that 3-day period. If I am found not using this service in good faith, Roommate Specialists has the right to terminate this agreement without recourse.

In consideration of the services to be rendered by Roommate Specialists and the rates charged therefore, the client or his or her legal representative agrees to and hereby releases Roommate Specialists and its employees, representatives, agents, successors and assigns, for the negligent or wrongful acts or omissions of its employees, agents, or representatives.

I agree that Roommate Specialists may reveal to persons it considers prospective roommates all information, not limited to, but including written, oral, and photographic material that either I or Roommate Specialists has provided. The privilege and responsibility of final selection, acceptance, or rejection of a roommate is to be mine.

I agree that this document embodies and is intended to embody the entire agreement between the undersigned and Roommate Specialists. Should the undersigned desire to reregister, upon a new verification of references, he or she shall be entitled to Preferred Status, which entities said client to a 10% discount of the original $60 fee (includes reverification of credit report $5 + $55 fee for service). All above conditions apply. Tennant is verified by above but this is a free service provided by Roommate Specialists to the tenant. All fees are paid by the landlord.

*I agree I disagree *Date: