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Register for a home form

Home Search Application Form

If you would like this form in another language or format please let us know.

You must answer all of the questions on this form. If you do not answer all of the questions your application will not be registered with Home Search. (Please ask if you need help to complete the form or require a translation. See the Information pack for more details).

1. APPLICANT DETAILS

Applicant

Full name: Title:

Date of birth:

Marital status: National Insurance number: Previous names:

Telephone number(s)

Home: Work: Mobile: Email:

Joint Applicant

Full name: Title:

Date of birth:

Marital status: National Insurance number: Previous names:

Telephone number(s)

Home: Work: Mobile: Email: Relationship to applicant:

2. CURRENT ADDRESS

Current Address Postcode:

Is this property a:

If Other (please state) What floor do you live on? (i.e. Ground, First): How many bedrooms are there?

Are you a:

Lodger
Tenant
Owner

Current Landlord’s name and address: Postcode: Contact address (if different from above): Postcode: Please tell us why we need to contact you at this address:

3. PREVIOUS ADDRESSES

Please list your previous addresses for the last five years. Please indicate Lodger, Tenant or Owner.

Applicant Previous Address 1:

Previous Address:		Date moved in:		Status
Previous Address:		Date moved out:

Applicant Previous Address 2:

Previous Address:		Date moved in:		Status
Previous Address:		Date moved out:

Applicant Previous Address 3:

Previous Address:		Date moved in:		Status
Previous Address:		Date moved out:

Applicant Previous Address 4:

Previous Address:		Date moved in:		Status
Previous Address:		Date moved out:

Joint Applicant Previous Address 1:

Previous Address:		Date moved in:		Status
Previous Address:		Date moved out:

Joint Applicant Previous Address 2:

Previous Address:		Date moved in:		Status
Previous Address:		Date moved out:

Joint Applicant Previous Address 3:

Previous Address:		Date moved in:		Status
Previous Address:		Date moved out:

Joint Applicant Previous Address 4:

Previous Address:		Date moved in:		Status
Previous Address:		Date moved out:

4. PEOPLE YOU LIVE WITH AT YOUR CURRENT ADDRESS

Please state the people who live with you now and also those who will live with you when you move. Please also state if they are Male (M) or Female (F). You will need to provide proof that any children included on your application are resident with you. If you are pregnant please provide proof of expected due date.

Person 1:

Name:	Live with you now:	Date of Birth: (dd) (mm) (yyyy)
	Yes No
Relationship to applicant:	Will live with you:	Sex:
	Yes No

Person 2:

Name:	Live with you now:	Date of Birth: (dd) (mm) (yyyy)
	Yes No
Relationship to applicant:	Will live with you:	Sex:
	Yes No

Person 3:

Name:	Live with you now:	Date of Birth: (dd) (mm) (yyyy)
	Yes No
Relationship to applicant:	Will live with you:	Sex:
	Yes No

Person 4:

Name:	Live with you now:	Date of Birth: (dd) (mm) (yyyy)
	Yes No
Relationship to applicant:	Will live with you:	Sex:
	Yes No

5. MUTUAL EXCHANGE

If you are a council or housing association tenant, you can be considered for mutual exchange.

Do you wish to be included in the mutual exchange register?

Yes
No

If yes, please visit www.ovh.org.uk or call 0300 365 1111 for more details about the Homeswapper service.

6. DISABILITY

Do any of the following apply to you, or someone else on your application?

If Other (please state) If not you, who does this apply to?

Are you a wheelchair user?

Yes
No

If yes, is this for use: If not you, who is the wheelchair user?

7. FINDING A HOME

Do you understand how to find out about homes available for letting and how to express an interest (bid) when they are advertised?

Yes
No

We use a proxy service. This means someone can bid on your behalf. If you would like someone to do this please provide the name and address of the person that you wish to act on your behalf.

Name and address: Postcode: Telephone number: Relationship to you:

If there is no one to act on your behalf a Home Search Officer can do this for you in some circumstances. Please contact a Customer Service Advisor for more information on 0300 365 1111.

8. ADDITIONAL SUPPORT

Do you receive support from anyone?

Yes
No

Do you give support to anyone?

Yes
No

If yes, who? Name and address: Postcode: Telephone number: Relationship to you: What support is given to you / what support do you provide?

9. INCOME

Please give details of your income and joint applicants' income. This information does not affect your application, but it will help us to assess whether you are entitled to Housing or Council Tax Benefit or will need help paying the rent.

	Applicant	Joint Applicant
Normal weekly take home pay	Applicant:	Joint Applicant:
Total weekly amount from pensions	Applicant:	Joint Applicant:
Total weekly amount from benefits (excluding Housing/Council Tax Benefit)	Applicant:	Joint Applicant:
Total weekly amount from other sources	Applicant:	Joint Applicant:
Total	Applicant:	Joint Applicant:

Applicant

Name, address and phone number of employer (if applicable):

How long have you been with this employer?

Years Months

Joint Applicant

Name, address and phone number of employer (if applicable):

How long have you been with this employer?

Years Months

10. DO YOU QUALIFY?

We need to establish whether you and anyone included in your application qualifies for housing.

Are you a British, European Union or Commonwealth Citizen with the right of abode? (This will appear in your passport.)

Applicant

Yes
No

Joint Applicant

Yes
No

If the answer is no, please provide proof that Applicant/Joint applicant has indefinite leave to remain in the United Kingdom.

Do you have European Union workers’ rights?

Applicant

Yes
No

Joint Applicant

Yes
No

11. AREA AND PROPERTY TYPE PREFERENCES

To help us to identify the location and type of property that you would prefer to be housed in please highlight your preferences below. This does not mean that we can re-house you according to your choices below, but this information will show us what you are considering bidding for and will allow us to give advice and assistance. You can of course express an interest in any type of property in any part of Sefton, providing you meet the advertised criteria, you are not restricted to the choices specified here.

What areas would you be interested in living in? (Please refer to the map in your Information booklet for guidance - tick all that apply):

What type of property would you be interested in living in? (tick all that apply):

12. ADDITIONAL INFORMATION

If you have any additional information you would like us to take into account when assessing your housing need including any racial, hate crime, or domestic harassment issues, please complete this section. Briefly describe why you need to move from your current home:

You may need to provide supporting documentation - if you require advice on what you need to provide, please contact us.

13. EQUALITY AND DIVERSITY

One Vision Housing is committed to delivering high quality services equally regardless of age, gender, transgender, disability, racial origin, religious beliefs or sexual orientation. To help us to monitor our policies and procedures, we would be grateful if you would answer the following questions. The information you provide will be treated confi dentially and will only be used for monitoring purposes. It will not be used to determine whether or not you are accepted onto the housing register or whether you will be made the offer of a property.

Gender	Applicant	Joint applicant
Is your gender identity the same as the gender you were assigned at birth?	Yes No	Yes No
What is your current gender?	Male Female	Male Female
	Applicant	Joint applicant
Age:	Under 18 18 to 24 25 to 59 60 to 74 Over 75	Under 18 18 to 24 25 to 59 60 to 74 Over 75
	Applicant	Joint applicant
Religion or belief:	No religion Bahai Buddhist Christian Hindu Jain Jewish Muslim Sikh Other Prefer not to say If Other (please state)	No religion Bahai Buddhist Christian Hindu Jain Jewish Muslim Sikh Other Prefer not to say If Other (please state)
	Applicant	Joint applicant
Sexual orientation	Bisexual Gay Woman/Lesbian Heterosexual Gay Man Other Prefer not to say If Other (please state)	Bisexual Gay Woman/Lesbian Heterosexual Gay Man Other Prefer not to say If Other (please state)
	Applicant	Joint applicant
Ethnic origin - What best describes your ethnic origin(s)?	Asian or Asian British: Indian Pakistani Bangladeshi Other If Other (please state) Black or Black British: Black Caribbean Black African Other If Other (please state) Chinese or other Ethnic Group: Chinese Gypsy Traveller Other If Other (please state) Mixed: White and Black Caribbean White and Black African White and Asian Other If Other (please state) White: British Irish Other Prefer not to say If Other (please state)	Asian or Asian British: Indian Pakistani Bangladeshi Other If Other (please state) Black or Black British: Black Caribbean Black African Other If Other (please state) Chinese or other Ethnic Group: Chinese Gypsy Traveller Other If Other (please state) Mixed: White and Black Caribbean White and Black African White and Asian Other If Other (please state) White: British Irish Other Prefer not to say If Other (please state)
Language	Applicant	Joint applicant
Is English your first language?	Yes No	Yes No
If no, please state language	Applicant	Joint Applicant

14. DECLARATION

Any information given will be completely confidential and will be considered only in relation to an application for accommodation by virtue of the Rehabilitation of Offenders Act 1974. Any processing of the information you have provided on this form will be in accordance with The Data Protection Act 1998 and The Crime and Disorder Act 1998.

Have you or anyone on your form been convicted of any criminal offence, including action for any racially motivated offence, or had legal proceedings taken for anti-social behaviour?

Yes
No

Do you or does anyone on your form owe money to a Local Authority, Housing Association or previous landlord?

Yes
No

Have you or has anyone on your form ever been evicted from a previous tenancy?

Yes
No

Are you or is anyone on your form related to a Councillor, Board Member or an employee working for One Vision Housing?

Yes
No

If you have indicated yes to any of the above please give details including dates:

I declare that the information I have given is full, true and correct. I understand that any false or misleading information, given by me or anyone acting on my behalf, may lead to legal action. I also understand that this action may result in loss of any tenancy granted by One Vision Housing or a fine imposed by the courts.

I understand that One Vision Home Search may need to conduct checks with other agencies and I authorise those agencies to release information to them on my behalf.

I understand that my form will be returned to me and/or my application cancelled if I have not given all of the information required.

Applicant:

Please confirm your name:

Joint applicant:

Please confirm your name:

You will be asked to sign the submitted form if your application is accepted.

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