Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Phone *

(###)

###

####

Home Phone

(###)

###

####

Are you Aboriginal or Torres Strait Islander? *

Yes, I'm Aboriginal and Torres Strait Islander

Yes, I'm Aboriginal

Yes, I'm Torres Strait Islander

No, I'm not

Prefer not to disclose

Employer contact number *

(###)

###

####

Your current housing circumstances *

Homeless

Temporarily staying with friends or familty

Community/social housing

Renting a private house or unit

Other

Are you a citizen of Australia? *

Yes

No

Are you a Permanent Resident? *

Yes

No

Do you need an interpreter for spoken English? *

Yes

No

Do you need to give notice at your current property? *

Yes

No

When would you be able to move in, if successful? *

MM

DD

YYYY

Household member 1

First Name

Last Name

Household member 2

First Name

Last Name

Household member 3

First Name

Last Name

Household member 4

First Name

Last Name

Reasons for leaving *

Overcrowded

Sub-standard

Travel time to work

Eviction

Distance from family

Too expensive

Other

Does any person included on this application have any of the following? Tick all that apply *

No household member has any of these things

Cash/savings

Car

Property/shares in a property

Business/shares in a business

Other assets

Have you ever participated in an Affordable Housing program in the past? *

Yes, please give details below

No

Have any of your previous tenancies been terminated? *

Yes, please give details below

No

Have you ever had a tenant of MCH Department of Communities and Justice (DCJ) or another Community Housing Provider? *

Yes, please give details below

No

Declaration

By clicking below you are confirming that you have read, understood and agreed to the following points:

*

I understand that if I provide false or misleading information, I may no longer be eligible for housing with Metro

*

I understand that for the purposes of this application Metro may contact my employer, current and/or former landlord and other references to confirm the information provided in this application.

*

I will inform Metro of any changes to my circumstances- personal or financial.

Conflicts of Interest *

A conflict of interest may arise in situations where someone with a personal relationship with a Metro staff member applies for housing. Please indicate below if you have/had a relationship with a Metro staff member and the nature of that relationship. lf this doesn't apply to your situation please mark 'Not Applicable'

Yes

Not applicable

Information on Privacy

Metro Community Housing collects, holds and uses information about you and/or your household members to assess your eligibility for housing in an attempt to provide you with housing assistance. Any information you provide in this application or by any other means is treated in accordance with Australian Privacy Principles. This means that: The personaI information you provide will only be used for the purpose mentioned above and will not be disclosed to anyone else without your consent. Where it is necessary to check the accuracy of the information provided, you consent to permit those checks to occur - and if those checks show different information, we will contact you to confirm the accuracy of that information. You may access that personal information upon request. lf you withdraw your application, the personaI information we hold about you will be destroyed. lf you would like a representative to speak to Metro Community Housing on your behalf you will need to provide written consent.