BOARDING HOUSE APPLICATION

1
Preferred Boarding House Locations in Auckland:* This field is required.
Central:
South:
East:
North:
2
Demographic Placement Preferences* This field is required.
Your Preference
Urgent Placement (open all)
Row 0, Column 0
Waitlist Placement (open all)
Row 1, Column 0
Aged 55+ (open to over age 55)
Row 2, Column 0
Woman's refuge (open to female only)
Row 3, Column 0
Urgent Placement (open all)
Waitlist Placement (open all)
Aged 55+ (open to over age 55)
Woman's refuge (open to female only)
Your Preference
Row 0, Column 0
Your Preference
Row 1, Column 0
Your Preference
Row 2, Column 0
Your Preference
Row 3, Column 0
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3
Tenant Full Legal Name:* This field is required.
4
Tenant Email for Service:* This field is required.
example@example.com
5
Tenant Date of Birth* This field is required.
6
Tenant WINZ Client Number:* This field is required.
7
Tenant Mobile Phone* This field is required.
8
Case Manager Name:* This field is required.
9
Case Manager Role / Job Title:* This field is required.
10
Case Manager Email:* This field is required.
example@example.com
11
Case Manager Mobile* This field is required.
12
Helpful notes, info, background from | Case manager | Tenant | Occupant (if needed, not required)
13
Friend Name:Helpful, but NOT required info
14
Friend Relationship:Helpful, but NOT required info
Mum, Dad, Friend, Mate ect
15
Friend MobileHelpful, but NOT required info
16
Friend Email:Helpful, but NOT required info
example@example.com
17
Preferred Tenancy Start Date* This field is required.
If known at this point
18
Boarding House Address:* This field is required.
If known at this point
19
Room number:* This field is required.
If known at this point
20
Your desired length of stay:* This field is required.
1 Month:
3 Months:
6 Months:
12+ Months:
21
What are your current circumstances, causing you to need accommodation?* This field is required.
22
Been arrested by the police after age 18:* This field is required.
Yes
No
23
Please provide info on criminal history information:
24
Been arrested for violence or drugs?* This field is required.
Yes
No
25
Please provide info on arrest for violence or drugs:
26
Been arrested for assault or battery?* This field is required.
Yes
No
27
Please provide info about arrest for assault or battery:
28
Been deported from Australia or other Country?* This field is required.
Yes
No
29
Please provide info on any deportation:
30
Been EVICTED from any other property, home or situation in the last 12 months?* This field is required.
Yes
No
31
Please provide more info on the EVICTION:
32
Currently on, recently stopped, in recovery from illegal drugs?* This field is required.
Yes
No
33
Please provide more info on drug use or history:
34
Physical, mental, or other disabilities that would prevent you from carrying out normal day to day activities?* This field is required.
Yes
No
35
Please provide info on disabilities, or special needs for our team to be aware assist any wrap around services:
36
Have you or are you currently registered with a social worker or mental health organisation?* This field is required.
Yes
No
37
Social Workers NAME & MOBILE & ORGANIZATION:
38
Required or prescribed any medication:* This field is required.
39
Are you under the supervision of the Department of Corrections?* This field is required.
Yes
No
40
Probation Officer Name & Location & Contact Number:
41
By signing this application, you understand that we will do our necessary checks and should your application be declined for any reason, you will not be offered a tenancy agreement and all or any bond or rent in advance will be refunded.
42
We require photo identification for ALL the applicants wanting to occupy a boarding house.
Do you consent to your information being disclosed to and from the Justice Department, Corrections Department and NZ Police: Yes
43
Signature of Applicant | Tenant | Occupant:* This field is required.
44
ID Upload Required* This field is required.
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