APPLICATION FORM. If you need help or advice on completing this form please contact us on or visit our website

Transcription

1 APPLICATION FORM If you need help or advice on completing this form please contact us on or visit our website I / we wish to be considered for a property at: Cloverleaf Grange, Bucksburn! Regency Place, Countesswells! Applicants Please complete the following information in BLOCK CAPITALS Applicant 1 Surname First Names Applicant 2 Surname First Names Are you currently a tenant of: Aberdeen City Council Yes! No! Other Registered Social Landlord in Aberdeen City Yes! No! Are you currently on a waiting list for housing through: Aberdeen City Council Yes! No! Other Registered Social Landlord in Aberdeen City Yes! No! - 1 -

2 Applicant 1 Full Name Current Address Post Code Tel. No. (Mobile) Tel. No. (Home) Tel. No. (Work) Address Date of Birth National Insurance No. Please specify your current employment status: Full-time! Part-time! Self-employed! Independent Means! Retired! Unemployed! Student! Other Occupation/Job Title: Employer Name: Employer Address: Post Code: Telephone No: Employed Since: Income Amount Please tick Salary/Wages weekly fortnightly monthly Housing Benefit weekly fortnightly monthly Income Support/UC weekly fortnightly monthly Maintenance weekly fortnightly monthly Student Grant weekly fortnightly monthly Private Pension weekly fortnightly monthly Child Benefit & Tax Credits weekly fortnightly monthly Other weekly fortnightly monthly Applicant 2 Full Name Current Address Post Code Tel. No. (Mobile) Tel. No. (Home) Tel. No. (Work) Address Date of Birth National Insurance No. Please specify your current employment status: Full-time! Part-time! Self-employed! Independent Means! Retired! Unemployed! Student! Other - 2 -

3 Occupation/Job Title: Employer Name: Employer Address: Post Code: Telephone No: Employed Since: Gross Annual Income (Before Tax) Income Amount Please tick Salary/Wages weekly fortnightly monthly Housing Benefit weekly fortnightly monthly Income Support/UC weekly fortnightly monthly Maintenance weekly fortnightly monthly Student Grant weekly fortnightly monthly Private Pension weekly fortnightly monthly Child Benefit & Tax Credits weekly fortnightly monthly Other weekly fortnightly monthly Current Housing Situation Please advise what you your current housing situation is i.e. whether you are in a private rent or social housing, residing at the family home / living with friends/relatives Condition of current property and neighbourhood Is the property in a good state of repair? Yes! No! Don t know! Is the property of reasonable energy efficiency Yes! No! Don t know! Are there any neighbourhood related issues? Yes! No! Don t know! If you answered No to any of the above questions, a home visit may be required in order to verify. Referencing Your application may be subject to referencing. Do you give your consent to this being undertaken if your application is selected to be progressed? Yes! No! Wish to discuss further! Please answer the following: Would we be able to obtain a landlord reference? Yes! No!* Would this be your first tenancy? Yes! * No! Have you previously been in rent/mortgage arrears? Yes! * No! - 3 -

4 Landlord/Leasing Agent Details Please give the name and address of your current/most recent landlord Landlord/Agents Name Landlord/Office Address Telephone No. Address Let Property Address Termination Date Previous Addresses (Previous 5 years) Address Landlord Name & Address From To Reason for Leaving - 4 -

5 Local Connection Do you have a local connection to the area in which the property you are applying for is located in i.e. children at local school, place of employment, family or support network? Yes! No! If yes, please give a brief description of your local connection Medical Conditions Do you have any medical conditions? If yes, could you please provide details and advise how a move would benefit your condition? Residency Status Nationality: Are you permitted to reside in the UK? Yes! No! Don t know! Criminal Convictions Do you have any criminal convictions? Yes! No! Conviction Date Sentence Convictions spent under the rehabilitation of offenders act 1974 need not be disclosed - 5 -

6 Household Composition Details of those who will be living with you in your new home Surname First Name(s) Date of birth Relationship to applicant(s) Are you/your partner pregnant or currently planning a family in the near future? Do you have any pets? Does anyone in your household smoke? Is your current household overcrowded? Are you fleeing domestic abuse, violence or harassment? Have you been asked to leave your current accommodation? Do you own one or more cars? Please add any additional information which would support your application, on the next page

7 Additional Information - 7 -

8 Signing the application form For joint applications both signatures are required. I / we understand that this form will be used for the purpose of assessing my / our eligibility for allocation. I / we acknowledge and explicitly give my / our consent to Osprey Housing for gathering, processing, disclosing and storing personal information about me / us in accordance with the Data Protection Act 1998, as will be required to process my / our application for housing. I / we confirm that the information provided in this application form is to the best of my / our knowledge and belief correct and accurate in all respects. I / we understand that giving false or misleading information may result in me / us becoming ineligible for housing with Osprey Housing. Signatory 1: PRINT NAME (Including title e.g. Mr/Mrs/Miss/Ms) Signature 1: Date: Signatory 2: PRINT NAME (Including title e.g. Mr/Mrs/Miss/Ms) Signature 2: All applicants must sign this form twice once here and once in the next section. The signature in the next section allows us to request information from your current landlord and also in relation to any waiting lists you are currently listed on

9 Allowing us to request and share information I / we hereby authorise (enter the name and address of your current landlord) Landlord/Letting agent Name: Landlord/Office Address: to release any information about my current tenancy which Osprey Housing might need in connection with my / our application. I / we also authorise (enter the names and addresses of any previous housing provider to release any information about my / our application which Osprey Housing might need in connection with my / our application to rent a home. (Please state previous landlords below) Name: Address: Tenancy Start Date: Tenancy End Date: Signatory 1: PRINT NAME (Including title e.g. Mr/Mrs/Miss/Ms) Signature 1: Date: Signatory 2: PRINT NAME (Including title e.g. Mr/Mrs/Miss/Ms) Signature 2: Date: - 9 -

10 Equal Opportunities Monitoring Please indicate your ethnic origin by ticking the relevant box. If you want to provide more details about your ethnicity, or if you feel the ethnic categories are too broad, please give more information in the box provided. Black, Black Scottish or Black British: African! Caribbean! Any other African or Caribbean background. Please give details. Asian, Asian Scottish or Asian British: Bangladeshi! Chinese! Indian! Pakistani! Any other Asian background. Please give details. White Scottish! Other British! Irish! Any other White background. Please give details. Gypsy Traveller! Mixed! Please give details. Other! Please give details I prefer not to say! DATA PROTECTION The information collected on this form is recorded manually and electronically, stored securely and processed for the purposes of assessing that you qualify for housing at any of our developments. Osprey Initiatives Ltd will process your information fairly and lawfully and in accordance with the principles of the Data Protection Act The information you provide may be used to contact you again in the future regarding a housing application