• APPLICATION FORM

    APPLICATION FORM

    ABN 33 110 787 286 ABN 21 601 714 845

  • Primary Contact Information

    Please provide the details of the primary contact for this application. This is the individual we will liaise with and send all communication regarding the application.

  • Applicant Information

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  • Next of Kin

  • Alternative Contact

  • Enduring Power of Attorney and Guardianship

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  • NDIS and Support Services

  • Medical Information

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  • Communication, Support and Physical Needs

    Please note, this is for assessment and suitability only to give an indication of the applicant's health and care needs. The following services are available for an additional fee over and beyond the cost of standard Board and Lodging.
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  • Personal History

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  • Income, Tenancy History and Referral Information

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  • Terms and Conditions

  • TERMS OF RESIDENCY

    1. Fees are required to be paid two weeks in advance.
    2. Applicants will not take up occupancy until all fees and charges are paid.
    3. Fees will be adjusted in line with full single pensioner payment including rental assistance, Centrelink increases etc.
    4. One week's notice, or one week's fees in lieu of notice, must be given if a resident wishes to vacate the facility.
    5. In the case of extended hospitalisation, the fees may be reduced on application after four weeks in hospital.
    6. The resident is responsible for all costs associated with transfer to and from a hospital.
    7. A key replacement fee of $40.00 will apply to lost or stolen keys.
    8. Residents are responsible for providing special food items i.e., gluten free bread, soy milk or Halal meat etc. at their own costs. This must be discussed at time of interview.
    9. Applicants/residents are to adhere to the Policy and Procedures of the facility, deviation from this may result in a Breach Notice or Notice to Terminate.
    10. Management reserves the right not to accept a referral.
    11. Skymac Pty Ltd and Australian Quality Care Pty Ltd adheres to the Residential Services Accommodation Act 2002.

    TERMS OF RESIDENCY

    We are an independently owned and operated business and are bound by the National Privacy principles. We collect personal information about you in this form to assess your Application for Tenancy. We may need to collect information about you from your previous Lessors or Letting Agents, your Employer and Referees. We will also check if details of Tenancy defaults by you are help on a Tenancy Database. Your consent for us to collect the information is set out below in the Privacy Consent section.

    COLLECTION NOTICE

    The personal information you provide in this application may be shared with relevant third-party organisations, including but not limited to Queensland Health. Should Queensland Health or other third-party organisations hold personal information relevant to my Tenancy Application, I consent to the sharing of this information with Skymac Pty Ltd. The information we collect from other sources is necessary to verify your identity, to process and evaluate the Application and to manage the Tenancy, if successful. If the Application is successful, personal information collected about you in this Application and during your Tenancy may be disclosed for the purpose for which it was collected to other parties including the Lessor, Referees, other Agents, and relevant third-party organisations. If you enter into a Rooming Agreement and if you fail to comply with your obligations under the Agreement, the facts and other relevant personal information collected about you during your Tenancy may also be disclosed to the Lessor, third party operators of Tenancy Databases and/or other Agents.

    You have the right to access personal information that we hold about you by contacting our Privacy Officer. You can also correct this information if it is inaccurate, incomplete, or out of date. 

    If you do not complete this form or sign the consent form below, the Application for Tenancy may not be considered by the owner of the relevant Property or, if considered, may be rejected, due to insufficient information to assess the Application.

    CHANGING THIS AGREEMENT

    Please let us know if you would like to discuss any changes to this agreement. If we agree that we can support these changes, a new agreement will be drafted for you to sign and return to us. If you want to end this agreement, you agree to give us 30 days’ notice. If we seek to end this agreement, we agree to give you 30 days’ notice. If either you or Skymac Pty Ltd seriously breaches this agreement, no period of notice will be required to end this agreement.

    By signing below, you acknowledge that you understand and agree to the terms and conditions listed in this document.

    PRIVACY CONSENT 

    I acknowledge that I have read the above Privacy Disclosure Statement and Collection Notice. I authorise Skymac Pty Ltd and Australian Quality Care Pty Ltd to collect and share information about me to:

    • My previous letting Agents and/or Lessor
    • My personal referees, employers and all other references on this application
    • Queensland Health agencies and relevant third-party organisations.

    I authorise Skymac Pty Ltd and Australian Quality Care Pty Ltd to refer my name and contact details to an arranger or service provider including tradespeople (to attend to work required at the Property), salespeople (primary and secondary Agents), valuers, other Agents, database operators.

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