Contour Application for Housing.qxd:Layout 1 - Contour Homes

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Who wants a Contour home Joint Applicants must complete pages 8 and 9 If you would prefer us not to contact you at home, please give an address where we can write to you: Address Postcode Have you or a member of your household applied to Contour Homes, Peak Valley Rivers (Hillock) HA, AvenQuest Homes, Portico or Collingwood HA before? Yes No If so what name did you apply in (if different)? and from what address? Postcode Have you or a member of your household been a tenant of Contour Homes, Peak Valley Rivers (Hillock) HA, AvenQuest Homes, Portico or Collingwood HA before? Yes No If so, what name was the tenancy in (if different)? What was the address? Postcode Do you have a social worker, probation officer or receive support from anyone else? Yes No If yes, give details Are you, or any of the people living with you pregnant? Yes No If so, when is the baby due? Please send us your Certificate of Confinement Equal Opportunity We have a policy of equal opportunity for all, irrespective of sex, colour, race or religious belief. To allow us to check that all applicants are treated fairly, please indicate what best describes your ethnic origin. Please tick one below from a, b, c, d, e or f. You Joint Applicant a) White British Irish Other You Joint Applicant You Joint Applicant You Joint Applicant b) Mixed White & Black White & White & Asian Other Caribbean Black African c) Asian or Indian Pakistani Bangladeshi Other Asian British d) Black or Black Caribbean African Other British e) Chinese or other Chinese Other ethnic group f) I do not want to answer this question 2
Equal Opportunity You Faith Joint Applicant You Joint Applicant You Joint Applicant Buddhist Christian Hindu Jewish Muslim Rastafarian Sikh Don’t wish to answer No religious affiliation Other (please state) Sexuality You Joint Applicant You Joint Applicant You Joint Applicant Heterosexual Bisexual Gay man Gay Woman/Lesbian Other Don’t wish to answer Who will be living with you? Do they live with Title Forename Surname Date of Birth Male/Female Relationship you now? If they do not live with you now, where do they live? Postcode 3
Page 1: Application for Housing Please retu
Page 5 and 6: What links do you have with the are
Page 7 and 8: Employment/Education Details Curren
Page 9 and 10: Employment/Education Details Curren
Page 11 and 12: Relationship to staff or committee

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