Adelaide Affordable Housing Application

Below is the application form for YWCA Australia’s Adelaide Affordable Housing property. For more information about the site, please visit the web page.

Step 1 of 3

33%

Applicant Information

Applicant given name/s(Required)

Applicant surname(Required)

Has your name changed legally within the last 5 years?(Required)

Yes - we will request proof for the next stage

Applicant’s Preferred Name or Alias

First Last

Date of Birth(Required)

Please enter as dd/mm/yyyy

Gender(Required)

Female

Male

Transgender

Non-binary

Indeterminate

Mobile(Required)

Email Address(Required)

Enter Email Confirm Email

Alternative Contact Details

Country of Birth(Required)

Primary Language Spoken(Required)

Interpreter Required(Required)

Yes

Indigenous Status(Required)

Aboriginal

Torres Strait Islander

Both

Not applicable

Pets(Required)

Include number of pets, size and breed eg; 2 dogs, small, both chihuahuas

Is the applicant or anyone in their household expecting a baby?(Required)

Yes

If yes, expected due date:(Required)

Please enter as dd/mm/yyyy

Is the applicant currently a car owner?(Required)

Yes

Additional Household Members

Is the applicant the only person in their household?(Required)

Yes

How many additional household members will there be?(Required)

Please note this refers to additional household members beyond the applicant themselves.

Name(Required)

First Last

Date of Birth(Required)

Please enter as dd/mm/yyyy

Relationship to Applicant(Required)

Gender(Required)

Female

Male

Transgender

Non-binary

Indeterminate

Type of Income(Required)

Gross Weekly Income(Required)

CRN(Required)

Name(Required)

First Last

Date of Birth(Required)

Please enter as dd/mm/yyyy

Relationship to Applicant(Required)

Gender(Required)

Female

Male

Transgender

Non-binary

Indeterminate

Type of Income(Required)

Gross Weekly Income(Required)

CRN(Required)

Name(Required)

First Last

Date of Birth(Required)

Please enter as dd/mm/yyyy

Relationship to Applicant(Required)

Gender(Required)

Female

Male

Transgender

Non-binary

Indeterminate

Type of Income(Required)

Gross Weekly Income(Required)

CRN(Required)

Name(Required)

First Last

Date of Birth(Required)

Please enter as dd/mm/yyyy

Relationship to Applicant(Required)

Gender(Required)

Female

Male

Transgender

Non-binary

Indeterminate

Type of Income(Required)

Gross Weekly Income(Required)

CRN(Required)

Current Accommodation

We require 2+ years of accommodation history. If you have been at your current address over 2 years, you do not need to note a previous address.

Current Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Are you the(Required)

Owner

Renter

How long have you been at this address? (years)(Required)

Please enter a number greater than or equal to 0.

How long have you been at this address? (months)(Required)

This field is hidden when viewing the form

length at address calc

Are you still at this address?(Required)

Yes

Reason for leaving(Required)

Rental provider /Agent(Required)

Rent provider/Agent contact number(Required)

Rent provider/ Agent Email(Required)

Rent paid(Required)

The rent amount above is paid:(Required)

per week

per fortnight

per calendar month

Previous Accommodation History

Previous Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are/were you the:(Required)

Owner

Renter

How long at this address (years, months)(Required)

Rental provider/Agent(Required)

Rental Provider/Agent Phone(Required)

Rental Provider/Agent Email(Required)

Rent paid(Required)

Per:(Required)

Week

Fortnight

Calendar Month

Current Employment

We require 2+ years of employment history. If you have been at your current employment over 2 years, you do not need to note a previous occupation.

Current Occupation(Required)

Nature of Employment(Required)

Full time

Part time

Casual

Self-Employed

Other

If you answered other, please specify the nature of employment(Required)

Employer’s Trading Name(Required)

Employer Contact Name(Required)

Employer Contact Phone(Required)

Employer Contact Email(Required)

Employer Address(Required)

Length of Employment (years)(Required)

Please enter a number greater than or equal to 0.

Length of Employment (months)(Required)

Please enter a number greater than or equal to 0.

This field is hidden when viewing the form

Length of employment calc

Gross income(Required)

This income is:(Required)

per week

per month

If self-employed:

Accountant's name(Required)

Company name(Required)

ABN(Required)

Phone(Required)

Email(Required)

Previous Employment

Previous Occupation(Required)

Nature of Previous Employment(Required)

Full time

Part time

Casual

Self-Employed

Other

If you answered other, please specify the nature of employment(Required)

Previous Employer’s Trading Name(Required)

Previous Employer Contact Name(Required)

Previous Employer Contact Phone(Required)

Previous Employer Contact Email(Required)

Previous Employer Address(Required)

Previous Job Length of Employment (years and months)(Required)

Previous Employment Gross Income(Required)

This income is(Required)

per week

per month

If previous job Self-Employment

Accountant's Name(Required)

Company name(Required)

ABN(Required)

Phone(Required)

Email(Required)

Additional Eligibility Criteria

Have you or anyone in your household experienced domestic or family violence?(Required)

Yes

Has an organisation supported you with (during or after) this experience?(Required)

Yes

Support Organisation Name(Required)

Was a Safety Plan completed?(Required)

Yes

Is there any ongoing risk to you or any members of your family?(Required)

Yes

If yes, please specify(Required)

Referees

We require at least one referee

First Referee Name(Required)

First Last

First Referee Relationship to Applicant(Required)

First Referee Phone(Required)

First Referee Email(Required)

Second Referee Name

First Last

Second Referee Relationship to Applicant

Second Referee Phone

Second Referee Email

Emergency Contacts and/or Next of Kin

By providing this contact information, you provide consent for YWCA Housing to contact your nominated Emergency Contact and/or Next of Kin in emergency situations, or should you not be contactable to conduct welfare checks.

Name(Required)

First Last

Relationship to Applicant(Required)

Phone(Required)

Email(Required)

Secondary Contact Name

First Last

Secondary Contact Relationship to Applicant

Secondary Contact Phone

Secondary Contact Email

Consent to Share Information

YWCA Australia (YWCA) will comply with relevant privacy legislation and standards for dealing with personal information as outlined in our Privacy Policy.

YWCA will work closely with other agencies to coordinate the best support for you. Your informed consent for the sharing of information will be sought and respected in all situations unless:

- we are obliged by law to disclose your information regardless of consent or otherwise,
- it is unsafe or impossible to gain consent or consent has been refused, or
- without information being shared, it is anticipated a child, young person or adult will be at risk of serious harm, abuse, or neglect, or pose a risk to their own or public health or safety.

Proposed use and disclosure of my personal information

The Applicants and each of them acknowledge and authorise the YWCA to make all necessary enquiries to verify the information provided herein, including information relating to employment, rental history and personal references under the provisions of the Privacy Act (SA) www.privacy.gov.au.

If you do not consent to the disclosure of your person information to those third parties we cannot process your application for a tenancy. We will collect and handle personal information about you in order to process your application for a tenancy. Primary Purpose Before a tenancy is accepted, we collect your information to assess the risk to our clients in providing you with the property you have requested to rent and, if considered acceptable, provide you with a tenancy for that property. In order to assess your application we disclose your personal information to:

- Referees to validate information supplied in your application
- Other Real Estate Agents to assess the risk to our clients

Secondary Purpose During and after the tenancy we may need to disclose your personal information to:

- Tradespeople to contact you for repairs and maintenance of the property
- Refer to Tribunals or Courts having jurisdiction seeking orders or remedies

Primary purpose consent(Required)

The primary purpose(s) of this service has been explained to me and I consent to the sharing of my personal information to assist in achieving the primary purpose(s).

Securing Private Information

YWCA Housing must comply with strict guidelines around who accesses the information and how the information is collected and stored. Applicant/Resident information is stored in accordance with The Privacy Act 1988 (Cth) and Privacy and Data Protection Act 2014 (Vic), all information will be stored securely to prevent loss or misuse.

Record of consent(Required)

YWCA Housing Staff, or my referring agency noted above, has discussed with me how and why certain information about me may need to be provided to other service providers.

I understand the recommendations and I give my permission for the information to be shared as detailed above.

I am submitting this application(Required)

For myself, as the applicant named above

As an authorised representative of the applicant named above

Name of Authorised Representative(Required)

First Last

Declaration(Required)

I, the applicant named above, hereby confirm that the information provided above is true and correct as at the date of clicking 'submit application'

Declaration(Required)

I, the authorised representative named above, hereby confirm that the information provided above is true and correct as at the date of clicking 'submit application'

YWCA Australia wishes to acknowledge the Traditional Owners of the lands on which we work, live and play and pay our respects to Elders past and present. We recognise First Nations people as the custodians of the lands, seas and skies, with more than 60,000 years of wisdom, connection and relationship in caring for Country.

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