The New Jersey Law Against Discrimination, N.J.S.A. 10:5-1 to -49, makes it unlawful to discriminate in the sale or rental of housing based on a person’s race, creed, color, national origin, ancestry, nationality, affectional or sexual orientation, disability, gender, marital status, familial status (whether you have a child, a parent-child relationship with a minor, or you are pregnant), lawful source of income or rental subsidy used for rental payments.
The New Jersey Division on Civil Rights is the State agency that is authorized to enforce the Law Against Discrimination. Under the Division’s Multiple Dwelling Reporting Rules, N.J.A.C. 13:10-1.1 to -2.6, the Division requires landlords to provide a summary of this information to the Division and to retain the information on this form. The information is used to prevent and eliminate discrimination in housing. Your cooperation in filling out this form will assist the Division in enforcing the Law Against Discrimination.
Please note that, although landlords must record certain information about the race and ethnicity of applicants and tenants, it is unlawful to record or ask applicants about other characteristics such as religion, gender, marital status or affectional or sexual orientation.
If you feel you have been denied housing or treated differently for one of the reasons listed above, you may contact the Division on Civil Rights at (609) 984-3138 for referral to a local Division office for additional information or assistance.
Visit the Division on Civil Rights Web site at: www.NJCivilRights.org.
If the tenant/applicatn chooses not to complete this form, the landlord or the landlord's representative is required to conduct a visual observation of the tenant or applicant and then complete this form as accurately as possible.
Race/Ethnicity: Please check all that apply to leaseholders(tenants) or applicants.
Black or African American: a person having origins in any of the original peoples of Africa.
Hispanic or Latino: a person of Cuban; Mexican, Puerto Rican, South or Central American or other Spanish origin or culture, or person having a Spanish surname.
Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native: a person having origins in any of the original peoples of North or South America
Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White or Caucasian: a person having origins in any of the original peoples of Europe, the Middle East or North Africa.
Occupants over the age of 18 shall complete application and pay non-refundable fee of $ each for credit report. In the event that this application is denied, any deposit, less the cost of credit report(s), shall be refunded to applicant.
By signing below, I authorize that the above information is correct and complete and authorize Landlord to obtain information it deems desirable in the processing of my application, including; credit reports, civil or criminal actions, rental history, employment/salary details, police and vehicle records, and any other relevant information. If I rent the unit, I understand the information on this form may be maintained in a tenant database for up to 5 (five) years after I vacate the premises. I also understand that the application fee is non-refundable, even if my application is rejected.
If this application is approved, the applicant must sign and return to Owner or authorized agent the lease and all pertinent addenda, together with all payments provided in the Lease within seven (7) days of receipt of documents. Receipt shall be established by certified mail as of the date of delivery. In the event that applicant does not return all documents and payments with in seven (7) days, the application shall be retained as liquidated damages without further notice to applicant.