Applicant contact details

1. First name *
2. Surname *
3. Date of birth * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
4. NI number *
5. Current address *
6. Phone number *
7. Email address

Applicant's requirements

1. Property type * Please choose Flat House Maisonette Bungalow Duplex Other
2. Number of Bedrooms I don't mind 1 2 3 4 5
3. Floor I don't mind Ground First Second Other
4. Area
5. Applicant has pets? * Yes
   No
6. Please provide more information

Referee details

Professional person only (Doctor, Solicitor etc)

1. Full name
2. Occupation
3. Relationship with referee
4. Current address
5. Phone number
6. Email address

Financial status

1. Employment status * Please specify: In receipt of full benefits Working part-time Working full-time
2. Employer details
3. Weekly hours worked
4. Weekly wage
5. Monthly benefits

Any other information

1. Please provide any other relevant information that you feel will support your referral:

* required field

Add a previous tenancy

Please list any previous tenancies in the last 3 years and reasons for termination

1. Address *
2. Termination reason *

Add Tenancy

* required field

Add an additional occupant

All additional occupants MUST be named

1. Full name *
2. Sex * Please Choose Male Female Other
3. Date of birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
4. Relationship to applicant *
5. Living permanently with applicant?

Add occupant

* required field

NB: Please be aware that supported referrals will receive priority with CanDo Lettings

Support worker details

1. Full name
2. Referring organisation
3. Phone number
4. Email address

Independent living

1. In your opinion, is the applicant ready for independent living?

Outstanding arrears

1. Does the applicant currently have any outstanding rent/service charge arrears?
2. Amount outstanding

Risk assessment - issues identified

1. Please include any information that may effect other tenants or staff e.g. history of violence, substance misuse, mental health, criminal record etc

* required field