Application for social rented housing in Orkney
Revised March 2014
Official Use Only
| OIC Date Received | OHAL Date Received | Name(s) | OIC Reg No. |
|---|---|---|---|
| OHAL App No. | Date of App. | Review Date |
|---|---|---|
IMAGE: The cover shows four photographs of social housing in Orkney, together with the Orkney Islands Council and Orkney Housing Association Limited logos.
About this application
This form is an application for the Common Housing Register. You will automatically be registered with Orkney Islands Council (OIC) and Orkney Housing Association Ltd (OHAL). If you do not wish to be housed by one of the housing providers please tick the relevant box.
- OIC ☐
- OHAL ☐
To register with both organisations leave the boxes blank.
For the purposes of this leaflet Orkney Islands Council will be referred to as OIC and Orkney Housing Association Ltd will be referred to as OHAL.
Failure to provide all the information requested will result in a delay to your application being processed. Once we have received your form we will acknowledge receipt within two working days. Once your application from has been assessed we will write to tell you the outcome of your application.
If you have any questions about the form, please contact either OIC or OHAL where a member of staff will be happy to help. See below for contact details.
Included in this pack is:
- Application Form
- Ethnic Monitoring Form
- Orkney Islands Council (OIC) Allocations leaflet
- Orkney Housing Association Ltd (OHAL) Allocations leaflet
Low Cost Home Ownership
Would you be interested in a mutual exchange and allow us to give your details to other people who are interested? (Council and Housing Association tenants)
Yes ☐ No ☐
Would you like to receive information on Low Cost Home Ownership?
Yes ☐ No ☐
If you have ticked “Yes” to the above we will send you further information and an application form.
This form can also be downloaded from the Internet at www.orkney.gov.uk or www.ohal.org.uk.
This application form is available, on request, in a range of different formats and other languages, for example large print and braille. If you require assistance in completing this form please contact one of the above housing providers.
Contact details
| Orkney Islands Council | Orkney Housing Association Ltd |
|---|---|
| Housing Services | 39A Victoria Street |
| Council Offices | Kirkwall |
| School Place | Orkney |
| Kirkwall | KW15 1NY |
| Orkney | |
| KW15 1DN | |
| Email: allocations@orkney.gov.uk | Email: allocations@ohal.org.uk |
| Tel: (01856) 873535 | Tel: (01856) 875253 |
| Fax: (01856) 886530 | Fax: (01856) 876764 |
Application form
1. Applicant details
| You | Joint applicant | |
|---|---|---|
| Title (Mr, Mrs, Miss, Ms) | ||
| Surname | ||
| Previous surname(s) | ||
| Forename(s) | ||
| Date of birth | ||
| National Insurance No. | ||
| Gender (please tick) | Male ☐ Female ☐ | Male ☐ Female ☐ |
| Relationship to applicant | N/A |
2. Information in another format or language
Do you require information in another format/language?
Yes ☐ No ☐
If “Yes” which format/language?
3. Address
| You | Joint Applicant (if different from main applicant) | |
|---|---|---|
| Address | ||
| Postcode |
Address for correspondence (if different from above):
| You | Joint Applicant | |
|---|---|---|
| Address | ||
| Postcode |
| You | Joint applicant | |
|---|---|---|
| Telephone no. (Home) | ||
| Telephone no. (Mobile) | ||
| Telephone no. (Work) | ||
| E-mail address |
4. Household members to be housed with you
Please continue on a separate sheet if necessary.
| Surname | Forename(s) | Date of Birth | Sex M/F | Relationship to you (main applicant) | Do they live with you Y/N | If No, please answer question 5 below |
|---|---|---|---|---|---|---|
5. Contact address
If No, please provide a contact address.
6. Other people who live at this address but will NOT be moving with you
| Surname | Forename(s) | Date of Birth | Sex M/F | Relationship to you (main applicant) |
|---|---|---|---|---|
7. Pregnancy
Are you, or anyone who is to be housed with you pregnant?
Yes ☐ No ☐
If “Yes”, what is their name?
When is the baby due?
Please provide a copy of form MAT B1.
It is important that you notify us when the baby is born.
8. Children from a previous relationship
Do you have contact with any children from a previous relationship who will not be housed with you?
Yes ☐ No ☐
If No, go to Question 11.
If “Yes”, please give details.
| Surname | Forename(s) | Date of Birth | Sex M/F | Relationship to you (main applicant) |
|---|---|---|---|---|
9. Overnight stays
Do they stay overnight?
Yes ☐ No ☐
If “Yes” how many nights per week?
10. Suitability of current accommodation
Are you unable to have your children stay with you because your current accommodation is unsuitable?
Yes ☐ No ☐
If “Yes” please state why.
11a. Present accommodation
Please tick one box that best describes your present accommodation.
| Accommodation type | You | Joint Applicant | Accommodation type | You | Joint Applicant |
|---|---|---|---|---|---|
| OIC tenant | ☐ | ☐ | Living with family/friends | ☐ | ☐ |
| OHAL tenant | ☐ | ☐ | Living with partner | ☐ | ☐ |
| Any other housing association | ☐ | ☐ | Lodger | ☐ | ☐ |
| Any other local authority | ☐ | ☐ | Refuge | ☐ | ☐ |
| Low-Cost Home Ownership | ☐ | ☐ | Hostel | ☐ | ☐ |
| Owner-occupier | ☐ | ☐ | Roofless/no fixed abode | ☐ | ☐ |
| Supported accommodation | ☐ | ☐ | In hospital | ☐ | ☐ |
| Private tenant | ☐ | ☐ | In prison | ☐ | ☐ |
| Tied accommodation | ☐ | ☐ | In halls of residence | ☐ | ☐ |
| Homeless accommodation | ☐ | ☐ | Subtenant | ☐ | ☐ |
| Other | ☐ | ☐ |
11b. Armed Forces
Are you currently a member or a Veteran of the Armed Forces?
Yes ☐ No ☐
If a Veteran when did you leave the Armed Forces?
Date: —
11c. Service personnel
Are you a widow, widower or other partner of service personnel killed in action?
Yes ☐ No ☐
If “yes” please provide the date of death.
Date: —
12. Rent arrears
Do you or the joint applicant have any current rent arrears with OIC, OHAL or any other social landlord?
Yes ☐ No ☐
13. Current accommodation
When did you move into your current accommodation?
14. Landlord details
If you live in rented accommodation, please provide details of your landlord.
Name and address of:
15. Written lease or agreement
Do you have a written lease or agreement with your landlord?
Yes ☐ No ☐
Please provide a copy of your lease and AT5, if relevant, with your application.
16. Type of property
What type of property do you live in?
House ☐ Flat ☐
If you live in a flat, which floor do you live on?
17. Bedrooms
How many bedrooms are there in your current home?
18. Facilities and condition
Does the accommodation have:
| Facility | Yes | No | Shared |
|---|---|---|---|
| Bath/Shower | ☐ | ☐ | ☐ |
| Kitchen | ☐ | ☐ | ☐ |
| Living-room | ☐ | ☐ | ☐ |
| Cooking facilities | ☐ | ☐ | ☐ |
| Inside flushing toilet | ☐ | ☐ | ☐ |
| Wash hand basin | ☐ | ☐ | |
| Piped water supply | ☐ | ☐ | |
| Hot water | ☐ | ☐ |
| Facility or condition | Yes | No |
|---|---|---|
| Mains electricity | ☐ | ☐ |
| Central heating | ☐ | ☐ |
| Dampness | ☐ | ☐ |
| Water penetration | ☐ | ☐ |
| Dangerous wiring | ☐ | ☐ |
| Other |
Please detail:
19. Reasons for applying for social housing
Please tick all that apply.
- To gain secure accommodation ☐
- To move to a larger property ☐
- To move to a smaller property ☐
- Employment reasons ☐
- Social/Medical reasons ☐
- Relationship breakdown ☐
- Suffering from harassment/violence ☐
- To support a relative ☐
- To receive support from a relative ☐
- Fleeing domestic abuse ☐
- Property in poor condition ☐
- To move to another area ☐
- Bereavement ☐
- Financial reasons ☐
- Independence ☐
- Leaving Armed Forces/other tied accommodation ☐
- No permanent address ☐
- Other (please specify below) ☐
Please provide further information on any of the above.
20. Medical condition
Does a member of your household suffer from a medical condition that is being affected by your current accommodation?
Yes ☐ No ☐
If “Yes” please provide the name of the person who is affected.
Condition:
How is the condition affected by your current accommodation?
21a. Support in an area of choice
Do you require to move into or remain in the area of your choice for support without which you would be unable to live independently?
Yes ☐ No ☐
If “yes” please provide the name and address of the person who will provide the support.
21b. Travelling to work
Do you have difficulty in travelling to your work from your current housing location?
Yes ☐ No ☐
Please specify.
22. Employment
Are you employed in your area choice and require to remain within that area to continue in this employment?
Yes ☐ No ☐
23. Housing support
Do you require housing support to help you maintain a tenancy eg home support worker, homecarer?
Yes ☐ No ☐
If “Yes” please give details of the support required.
24. Care or support professionals
Do you have a care manager, social worker or occupational therapist?
Yes ☐ No ☐
If “Yes” please give their name and address.
25. Threatened with homelessness
Are you threatened with homelessness? A person is defined as being threatened with homelessness if he or she is likely to become homeless within two months.
Yes ☐ No ☐
If “Yes”, by what date are you expected to leave?
Why do you have to leave?
If you are threatened with homelessness, please provide copies of any documents such as a Notice to Quit and/or Notice of Intention to Repossess.
26(a). Main Applicant
Please provide details below of all addresses over the last 5 years.
Continue on a separate sheet if necessary.
Previous Address 1
| Details | |
|---|---|
| Previous Address 1 | |
| Date from | |
| Date to | |
| Were you a tenant/lodger/owner/living with family etc (refer to Q11) | |
| Name and Address of Landlord (if applicable) | |
| Reason for leaving |
Previous Address 2
| Details | |
|---|---|
| Previous Address 2 | |
| Date from | |
| Date to | |
| Were you a tenant/lodger/owner/living with family etc (refer to Q11) | |
| Name and Address of Landlord (if applicable) | |
| Reason for leaving |
Previous Address 3
| Details | |
|---|---|
| Previous Address 3 | |
| Date from | |
| Date to | |
| Were you a tenant/lodger/owner/living with family etc (refer to Q11) | |
| Name and Address of Landlord (if applicable) | |
| Reason for leaving |
Previous Address 4
| Details | |
|---|---|
| Previous Address 4 | |
| Date from | |
| Date to | |
| Were you a tenant/lodger/owner/living with family etc (refer to Q11) | |
| Name and Address of Landlord (if applicable) | |
| Reason for leaving |
26(b). Joint Applicant
Please provide details below of all addresses over the last 5 years.
Continue on a separate sheet if necessary.
Previous Address 1
| Details | |
|---|---|
| Previous Address 1 | |
| Date from | |
| Date to | |
| Were you a tenant/lodger/owner/living with family etc (refer to Q11) | |
| Name and Address of Landlord (if applicable) | |
| Reason for leaving |
Previous Address 2
| Details | |
|---|---|
| Previous Address 2 | |
| Date from | |
| Date to | |
| Were you a tenant/lodger/owner/living with family etc (refer to Q11) | |
| Name and Address of Landlord (if applicable) | |
| Reason for leaving |
Previous Address 3
| Details | |
|---|---|
| Previous Address 3 | |
| Date from | |
| Date to | |
| Were you a tenant/lodger/owner/living with family etc (refer to Q11) | |
| Name and Address of Landlord (if applicable) | |
| Reason for leaving |
Previous Address 4
| Details | |
|---|---|
| Previous Address 4 | |
| Date from | |
| Date to | |
| Were you a tenant/lodger/owner/living with family etc (refer to Q11) | |
| Name and Address of Landlord (if applicable) | |
| Reason for leaving |
27. Anti-social behaviour
Have you, or anyone you want to live with you, been evicted for anti-social behaviour or been served with an anti-social behaviour order (ASBO)?
Yes ☐ No ☐
If “Yes” please give details including the name of the person, date ASBO was granted, and the name and address of your landlord at the time the order was served.
28. Registration with the police
Are you, or anyone to be rehoused with you, required to register with the police under the Sexual Offenders Act 2003 or any other reason?
Yes ☐ No ☐
If “Yes” please give details of the person registered.
29. Right to reside in the UK
Do you and everyone to be housed with you have the right to reside in the UK?
Yes ☐ No ☐
If “No” please give details on a separate sheet.
30. Areas of preference
Please complete the area(s) you wish to be re-housed in order of preference.
Please enter between one & a maximum of 4 areas you would consider.
Please note “anywhere” cannot be accepted.
See enclosed map for locations of where OIC and OHAL currently have properties. If you are looking for accommodation in an area where we do not have any properties, you can still specify this as an area choice and this information will be used to measure demand for future building projects.
31. Type of property
What type of property would you consider? Please tick all that apply.
- House ☐
- Flat ☐
- Bedsit ☐
32. Housing requirements
Do you require:
- Ground Floor ☐
- Sheltered ☐
- Supported ☐
- Wheelchair Adapted ☐
There may be medical criteria to qualify for these housing types.
33. Additional information
Please provide any additional information you feel is relevant to your application for housing.
Continue on a separate sheet if necessary.
Ensure form is signed overleaf.
Declaration
This section must be read and signed by the main and joint applicant. If you fail to sign this application we will be unable to process it and it will be subsequently returned to you for completion.
I/we declare that to the best of my/our knowledge, the details I/we have entered on the application form are true and accurate.
In accordance with Data Protection Law, please refer to OHAL’s Housing Applicant Fair Processing Notice (copy enclosed and available on our website at http://www.ohal.org.uk/fairprocessingnotices/FPN_-_OHAL_housing_applicants.pdf) which covers the collection, processing, storage, sharing and retention of your data.
The information you have supplied on this form will be used to determine your application for housing. The legal basis for processing this information for OIC is to provide a public service. More information about how OIC will use your information and your rights is available on the website at http://www.orkney.gov.uk/Online-Services/privacy.htm and a leaflet is enclosed.
Part 1
I declare that I am not a member of staff, nor related to a member of staff, of OHAL or OIC nor am I related to a Management Committee (MC) member of OHAL or someone who has recently been a MC or staff member.
Applications are accepted from people who are unable to make the above declaration but special procedures must be followed. If you are unable to make the declaration please give details of any relationship below.
| Staff/MC Relationship to you |
|---|
If you wish to be housed by either OHAL or OIC you are consenting to allow all information contained in this form (and any other documentation in relation to this application unless otherwise stated) to be shared, with both parties. If you choose only one landlord, the information will not be shared.
Please note that you may be asked security questions when you contact either OHAL or OIC before we can proceed with your enquiry.
Part 2
In the case of a joint application, both applicants must sign the declaration below. I/we have read the information above and agree to the declaration.
I/we understand that if my/our circumstances change (eg change of address), I/we must immediately notify OHAL and/or OIC.
Should you knowingly give false information and are housed as a result of this legal action may be taken to terminate your tenancy.
| Signature of applicant | Date |
|---|---|
| Signature of joint applicant | Date |
|---|---|
For Office Use Only
ACTION SHEET
| Date | Circumstances reported and outline of action required | Officer Initials |
|---|---|---|
IMAGE: The action sheet is a blank office-use form with columns for the date, circumstances reported and outline of action required, and officer initials.
Equal Opportunities Monitoring
Please tick as appropriate for the main applicant.
In line with Orkney Islands Council’s and Orkney Housing Association Ltd’s Equal Opportunities Policies we operate a monitoring procedure to record the sex and ethnic origin of all people applying for housing. This is to ensure that no group is at a disadvantage.
1. Sex
- Male ☐
- Female ☐
2. Age Bracket
- 16–24 years ☐
- 25–65 years (current state retirement age) ☐
- 66 years or over ☐
3. Disability
Do you consider yourself to have a disability?
Yes ☐ No ☐
4. Ethnic origin
- I choose not to answer ☐
White
- Scottish ☐
- Other British ☐
- Irish ☐
- Gypsy/Traveller ☐
- Polish ☐
- Any other white background ☐
Mixed or other multiple ethnic background
- Mixed or other multiple ethnic background ☐
Asian, Asian Scottish, Asian British
- Indian ☐
- Pakistani ☐
- Bangladeshi ☐
- Chinese ☐
- Any other Asian background ☐
Black, Black Scottish, Black British
- Caribbean ☐
- African ☐
- Any other black background ☐
Other ethnic background
- Arab, Arab Scottish or Arab British ☐
- Any other group ☐
- Unknown ☐
Date:
Thank you for your co-operation.