HOMS Online Residential Application


	H.O.M.S. Housing Outreach for Muslim Sisters	PO BOX 152611 Arlington, Texas 76015

If you have any problem using this form, please email us your information.
IMPORTANT: Do not forget to print out the actual application here, fill it out completely, sign it and mail it to us at the post office box address above. If we do not receive the printed application, the application process will cease. This online application is to accelerate the application process for potential residents.
Note: This form is not encrypted.

H.O.M.S. ONLINE APPLICATION FORM

Full Legal Name:

Muslim Name:

Social Security Number:

Drivers License number (include the state it was issued):

INS Status (if applicable):

Current street address:

Current city, state and zip code:

Prior street address (if less than 2 yrs):

Prior city, state and zip code:

Mother's maiden name:

Mother's phone number and address:

Father's Name:

Father's phone number and address:

Your current marital status:

Husband's Name (if applicable):

Husband's phone number and address:

Employer's Name:

Employer's phone number and address:

List three (3) personal references with phone numbers:

Reference 1:

Reference 2:

Reference 3:

Your email (if applicable):

Background Investigation Inquiry Release

In connection with my application with H.O.M.S, I understand that investigative background inquiries are made on myself including criminal and other reports. I understand that H.O.M.S will be requesting information from various federal, state and other agencies which maintain records concerning my background as it pertains to criminal activity. I authorize, without reservation, any party or agency contacted by this organization to furnish the above mentioned information and hereby release. and agree to hold harmless and/or to indemnify, this organization and any party or agency providing such information, from any and all liability arising from the request of, use of, or furnishing of such information. If you will be driving a facility vehicle please fill in driver’s license number and the state in which the license is issued.

List each city and state you have lived and worked in during the following years:

1999:

1998:

1997:

1996:

1995:

Have you ever been convicted of a crime other than a misdemeanor traffic violation?
(Convictions will not necessarily disqualify applicant)

Yes
No

If yes, please fully explain and provide name of offense and the city or state where the offense occurred.

Background Check Authorization
(By typing your name here, you are authorizing H.O.M.S. to perform a background on you based on the information you have given)

Future Revisions and Additions of Household Guidelines Clause:

The H.O.M.S. board reserves the right to make any revision or addition to the H.O.M.S. Household Guidelines at any time. In addition, residents must comply with any new program or guideline that is approved by the H.O.M.S. board and is added to the aforementioned household guidelines.
I acknowledge that I have read the H.O.M.S. Household Guidelines completely, and I understand the terms of my residence. I also acknowledge that I have received a personal copy of the Household Guidelines Handbook.