Picnic Bay Estates Employee Housing Application

Applicant Name:*

E-mail Address:*

Phone Number:*

Can you receive text messages on this phone?*

Yes

Current Address:*

Do you have a co-applicant? (Include anyone over the age of 18)*

Yes

Co-applicant name:

Co-applicant e-mail:

Co-applicant current address:

Co-applicant phone number:

Can you receive text messages on this phone?

Yes

Declaration

Are you now or have you ever lived in government subsidized housing?*

Yes

Has your housing assistance ever been terminated for fraud, non-payment, or any other reason? *

Yes

References & Emergency Contacts

Provide two references, including full name, address, and phone number for each:*

Provide 1 – 2 emergency contacts, including full name, address, and phone number for each:*

Household Composition

For EVERYONE who will live in the home, provide: name, relationship, birthdate, and last 4 of social security number
(Example: Jane Doe, Wife, 11-11-1966, female, 7654. Example: Joe Doe, son, 1-23-2024, 3456)*

Does anyone in your household require medically necessary handicap modifications?*

Yes

Do you expect your family size to change?*

Yes

Maybe

Current and Previous Housing Status

Current Landlord Name:*

Current Landlord Address:*

Current Landlord Phone Number:*

Current Monthly Rent:*

Current # of Bedrooms:*

Current # of Occupants:*

Do you have additional residences to list?*

Yes

Previous Landlord Name:*

Previous Landlord Address:*

Previous Landlord Phone Number:*

Previous Monthly Rent:*

Previous # of Bedrooms:*

Previous # of Occupants:*

Certifications and Signature

I understand to live in Picnic Bay Estates I must be a full-time employee of the Grand Portage Lodge, Casino, Trading Post, or Operations.

I understand rent is automatically deducted from my paycheck.

I understand there is a No Pets policy.

I certify that if selected to move into Picnic Bay Estates it will be my only residence.

I authorize the manager without liability to verify all information provided and to contact previous landlords and references and contacts.

I certify statements made in this application are true and complete to the best of my knowledge and belief.

I understand false statements or information is punishable under Federal and/or Tribal Laws.

Signature (Typing your name below constitutes a legally binding electronic signature)*

Date*