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CARBERY HOUSING ASSOCIATION
SOCIAL HOUSING FOR AND BY THE COMMUNITY
C/O WCBS
37, NORTH STREET,
SKIBBEREEN,
CO. CORK.
SECRETARY
TEL. 028 21890
FAX 028 21897
APPLICATION FORM
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PERSONAL DETAILS |
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NAME |
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ADDRESS |
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TELEPHONE/FAX |
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E-MAIL |
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PERSONS INCLUDED IN THIS APPLICATION |
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NAMES |
RELATIONSHIP |
AGE |
CURRENT ADDRESS |
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ARE YOU ON THE CORK COUNTY COUNCIL HOUSING LIST?
(TICK ONE) |
YES |
NO |
HOW LONG HAVE YOU BEEN ON THE LIST? |
YEARS |
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ARE YOU ON ANY OTHER HOUSING LIST? (E.g. other Council, housing
association) |
YES |
NO |
WHOSE?
(Please state) |
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CURRENT ACCOMODATION
(Give details of current accommodation and if not adequate, why.
E.g. temporary, not affordable, overcrowded, etc.) |
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EMPLOYMENT STATUS (TICK) |
Employed |
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Unemployed |
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Other
(state which) |
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ACCOMODATION REQUESTED |
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NUMBER OF BEDROOMS |
ONE |
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TWO |
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THREE |
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FOUR |
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MORE (State No.) |
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TENURE
(You will need to get a mortgage for shared ownership and low
cost shared ownership, so you must be employed) |
RENTED |
SHARED-OWNERSHIP |
LOW-COST HOME OWNERSHIP |
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OHER FACILITIES.
(Tick as appropriate) |
WORKSPACE |
STORAGE |
GARDEN |
OTHER (STATE WHICH) |
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DO YOU WANT YOU HOME TO BE? (Tick one) |
YES |
NOT
CONCERNED |
DO YOU WANT YOU HOME TO BE? |
YES |
NOT
CONCERNED |
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ENERGY EFFICIENT |
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LOW MAINTENANCE |
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SUSTAINABLE CONSTRUCTION |
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OTHER
(STATE WHAT) |
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DO YOU WANT A SEPARATE COMMUNITY FACILITY? (TICK ONE) |
YES |
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NO |
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NOT SURE |
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WHAT SHOULD THIS COMMUNITY FACILITY BE (TICK ONE ) |
CHILDCARE
FACILITY |
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ALLOTMENTS |
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RECYCLING |
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OTHER (STATE WHICH) |
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WAHTS IS YOUR EMPLOYMENT STATUS (TICK ONE) |
EMPLOYED |
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SELF-EMPLOYED |
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UNEMPLOYED |
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OTHER
(state
which?) |
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WOULD YOU BE INTERESTED IN TRAINING ARISING FROM THIS PROJECT? |
YES |
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NO |
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NOT SURE |
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IF SO, IN WHAT FIELDS |
CONSTRUCTION |
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CHILDCARE |
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PERMANCULTURE |
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ADMINSTRATION |
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HOUSING MANAGEMENT |
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OTHER (STATE WHICH) |
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WHAT AREAS ARE YOU PREFER TO BE HOUSED IN? (IN
ORDER OF PRIORITY) |
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BALTIMORE |
SKIBBEREEEN |
LISHEEN |
CASTLE TOWNSEND |
DUNMANWAY |
BANTRY |
OTHER (Please state) |
OTHER (please state) |
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DO YOU AGREE TO THIS INFORMATION BEING MADE AVAILABLE TO CORK
COUNTY COUNCIL AND OTHER OFFICIAL BODIES? (PLEASE TICK) |
YES |
NO |
YES, BUT WITH CONDITIONS (PLEASE STATE) |
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"I hereby apply for housing from Carbery Housing Association
(pending registration). I understand that CHA are a registered
voluntray houisng body, approved by the DoE, but cannot at present
make any offer of housing to me, and that any offer made to me in
future would have to be approved by Cork County Council. This
information will be used to inform the development of project
proposals by CHA, and the information is confidential to the
applicant and the board of CHA, and will only be disclosed to third
parties (e.g. County Council) with the applicants consent.
Signing this application does not commit me to any payment or
contribution to CHA, and I consent that CHA or the Council may
verify the facts stated above at a later stage. I also understand
that to knowingly provide false information could disqualify me from
any housing that might be secured by CHA."
Signed:
Name:
Date:
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Please return this completed form to Carbery Housing Association ,
c/o WCBS, 37 North Street, Skibbereen, Co. Cork.
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