Application for Housing

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					Application for Housing
Supported Housing Ltd
Melbourne Affordable Housing
Trading as Housing Choices Australia
Level 4, 333 Queen Street,
Melbourne, VICTORIA 3000




      HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street, Victoria 3000
             Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au
    Housing Application Form

    General Instructions

    Thank you for your enquiry about community housing.
    The purpose of this form is to identify prospective tenants.
    It is NOT an agreement to provide rental accommodation.

    If you are offered housing your lease will be with Supported Housing Ltd. or Melbourne
    Affordable Housing. Supported Housing Ltd and Melbourne Affordable Housing are
    both non-profit registered housing associations.

    All information provided to Housing Choices Australia will remain confidential and is
    needed to assess the applicant’s eligibility and suitability for a rental property.

    Please complete the twelve sections of this form in as much detail as possible.

    If you need more room for an answer, please use the space at the end of this form.
    What you say on this form will be used to make our first assessment of your
    application.

    Please attach any supporting letters or documents.
    You may also be asked to provide further detail at a later stage.

    Completed application forms are to be sent to:

        Housing Choices Australia
        Level 4, 333 Queen Street,        OR
        Melbourne VICTORIA 3000


    Email to:
    Email: Housing.application@hcau.org.au


    Please mark in number order (1, 2, 3) your choice of housing location provided by
1   Housing Choices Australia.

    (A detailed location list is available)


          INNER CITY                                       BARWON REGION


          NORTHERN REGION                                  EASTERN REGION


          WESTERN REGION                                   SOUTHERN REGION


          ALL OF THE ABOVE




    2               HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street Melbourne VIC 3000
                            Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au
    Housing Application From

2   Housing Applicant Details

    Contact Details
    Name

    Postal address       Street


                         City                                                 Postcode




                        Contact telephone                      Mobile Telephone


    Email address


                                                                 Please tick the box


           Date of                _____ / _____ / ______               Male                 Female
           Birth

    Are you, or anyone to be housed with you, an Aborigine or
    Torres Strait Islander?                                                      Yes           No

    Citizenship and Interpreters
    If you were not born in Australia, are you a
    permanent resident of Australia?                                            Yes            No
    In which country were you born?
    Please state your preferred language
    Is an interpreter required for your language?
                                                                                Yes            No
    If you were not born in Australia please provide ONE of these:

    - a certificate of Australian Citizenship
    - a passport, or
    - confirmation of an application for permanent residency


3   Other people who will live with you

    Please list everyone who will live with you.
    Please CROSS the last column if they are NOT living with you now.

                                     Sex       Date of
            Full Name                                        Age          Relationship to you        X
                                     M/F        Birth
                                                                        Relative? Friend?




    3               HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street Melbourne VIC 3000
                            Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au
    Housing Application From

    Accommodation needs
    Are you or any one to be housed with you
    expecting a baby?                                                          Yes          No
    Do you have any pets?
                                                                               Yes          No
    Do you own a vehicle?
                                                                               Yes          No
    If yes, write vehicle registration:

    How many bedrooms do you need?


    What type of housing do you want? (Tick one or more.)


         No preference                                    House

         Unit-ground floor                               Other (please specify)

         Apartment or flat

    People with disabilities (modifications)
    If you or a member of your household has any disability or serious health problem,
    please explain how this affects your housing needs
    (e.g. unable to manage stairs, need modifications)




    People with special needs (location)
    If you have any other needs or preference please give details
    (e.g. location needs to be near a hospital)




4   Public Housing

    Do you have an application for rental housing with the
    Office of Housing?                                                         Yes          No
    If YES, what is the application number?




    4              HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street Melbourne VIC 3000
                           Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au
               Housing Application From

       5       Current Housing

               Have you ever been a tenant of
               Supported Housing Limited, Melbourne Affordable Housing                         Yes       No
               OR Housing Choices Australia?

               What is your current housing?


                    Private Rental                                      Emergency accommodation

                    Public Housing                                      Transitional housing

                    Rooming house/hotel                                Family/friends


                    Supported residential service                      Hospital/rehab unit


                   Refuge or hostel                                    Other (specify)
               Length of stay at current address:
               Why do you need or want to leave your current accommodation?




               Agent details:        Name (landlord, agent or housing provider)

                                     Agent or Providers Phone no.                       Weekly rent paid
                                                                                        $
               Current               What is your current residential address?
               residential           Street
               address:
                                     City                                   Postcode




     6         Your income
               Income limits are described at www.hcau.org.au
               Housing eligibility is based on your gross (before tax) household income.

               What kinds of income do you have? Please tick ONE or MORE of the following boxes.
Please
attach         Where amounts are requested, please insert fortnightly amounts.
income
documents
as specified       Salary/wages                    $                   Overseas pension              $
in section 9


                   Superannuation                  $                   Self employed

                   Centrelink – DSP                                    Youth allowance

                   Centrelink – AGE                                    Newstart

                    Centrelink – Parent payment

                   Other (specify)
               5                HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street Melbourne VIC 3000
                                        Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au
               Housing Application Form

               Self-employed

               Are you self-employed?            Yes          No               Taxable income           $

               Business Name                                                    ABN




               Employment History
               Current employment details:

               Your occupation
               Employer’s name         Write BUSINESS name here


               Employer’s address      Street

                                       City                                            Postcode


                          Contact: Manager                                             Contact telephone
                                       Person to CONTACT at your PLACE of employment



               Length of              Years      Months                                Gross income fortnightly
               employment                                                              $


               Previous Employment details:

               Your occupation                                Employers name

               Length of              Years      Months                                Gross income fortnightly
               employment                                                              $



     7         Assets

               Asset limits apply.

               Do you or anyone with you own or part own any real estate
Please
attach asset   including land, a house, unit, flat or commercial property?                        Yes       No
documents
as specified
in section 9    * A Titles Office search will be conducted to confirm details.
               Do you have assets that give you an income?
               For example; investments, savings etc                                              Yes       No

               Please give details:




               6             HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street Melbourne VIC 3000
                                     Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au
     Housing Application Form

8    Contacts/References/Support worker

     Please provide two personal references (not related to you)

     1            Surname                               Given Name/s



                  Relationship to you                   Telephone number



     2            Surname                               Given Name/s



                  Relationship to you                   Telephone number




9    Documents required with your application
     Proof of identity

     Before an application will be considered the applicant must provide a legible copy of
     identification such as a
     - vehicle licence,
     - passport, or
     - Medicare card.


     Documents required to assess total income
     Assets                                          Income

     Please provide documentation of your            Please provide documentation of your
     assets, including:                              income, for example:

     -bank accounts                                  - at least 13 weeks of pay slips,
     - title documents                               - a tax return statement,
     - superannuation funds                          - a statement from Centrelink not more
       (which can be accessed)                         than two weeks old,
     - stocks & shares                               - a profit & loss statement,
     - recreation vehicles – e.g. boat, caravan      - child maintenance payments
                                                     - any other documentation



10   Declaration to be signed by the application
     I declare that all the information requested in this Application for Housing has been
     provided and is true and correct.

     Full name of applicant        Applicant                               Date
     Print                          Sign here



     Full name of witness          Witness                                Date
     Print                          Sign here




     Please sign Section 11 before lodging this form
     7             HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street Melbourne VIC 3000
                           Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au
     Housing Application Form

     Consent to use information

11   Declaration to be signed by the applicant
             Write your full name

     I,
             Write your full address
     of

     Hereby authorise Supported Housing Ltd and Melbourne Affordable Housing (trading
     as Housing Choices Australia) to use the information I have provided to confirm and
     clarify my housing application.

     I agree that only details which directly relate to my housing application can be
     discussed.

     I understand that the information I have given will be used for the sole purpose of
     clarifying issues that relate to my application for housing, and will be used for no other
     purpose.

     Signatures:

     Full name of applicant                            Applicant                         Date


     Full name of witness                              Witness                            Date




     You may withdraw this consent at any time by writing to Housing Choices Australia.
     We will contact you at your current address (section 2 on this form).



12
     Consent for HCA to notify the Office of Housing

     Please note. If you have an approved application with the Office of Housing (OOH)
     and you accept the long term housing and sign a lease with Supported Housing Ltd
     or Melbourne Affordable Housing (trading as Housing Choices Australia), we will
     advise the Office of Housing and they will remove your application from their waiting
     list.

     I,      Write your full name


     consent to Supported Housing Ltd or Melbourne Affordable Housing (trading as
     Housing Choices Australia) advising the Office of Housing of my acceptance of long
     term housing and agree to have my OOH application number
     removed from the OOH waiting list.

     Signature:
     Full name of applicant               Applicant                         Date
     Print                                 Sign here




     Have you signed the declaration (section 10)?


     8                    HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street Melbourne VIC 3000
                                  Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au
Additional material in support of your application




Updated September 2009




9               HOUSING CHOICES AUSTRALIA Level 4, 333 Queen Street Melbourne VIC 3000
                        Tel: 1300 312 447 Fax: 1300 312 737 www.hcau.org.au

				
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