First Name Last Name Telephone Email Enter your address Are you in recovery from drugs and/or alcohol? Drugs Alcohol Both Neither Other What is your sobriety date? List all drugs you've actively used What kind of meetings do you attend? Do you currently take prescribed medication? * Yes No Employment History Yes No Are You Employed Residency PlanningAre you able to pay $250 upon entering the house? $75 security deposit + $175 first week rent = $250 Yes No Have you ever lived in a sober living house before? * Yes No When would you like to move in? * Can you pass a drug screen? * Yes No Acknowledgements Check the box if you've read and understand the following *Kingdom Seekers to which you are applying requires that all members abstain from the use of alcohol or any illegal drugs and any member who violates policy will be expelled immediately. All members are responsible for maintaining peace within home and immediate area. Any member who disturbs the peace of Kingdom Seekers community will be expelled immediately. In accepting these terms, you claim you understand that these conditions are different than the normal due process afforded by some local landlord-tenant laws? Send
