Residential tenancy application

Elite Rooming Houses

Is this room required for a single or couple? *

Single
Couple
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Single/Couple

Based on the availability information that you have received, which room are you applying for?

Which room?

Room 1
Room 2
Room 3
Room 4
Room 5
Room 6
Room 7
Room 8
Room 9
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If you are flexible on room or property, please let us know here

Personal Information:

First Name *

Last Name *

Resident 2 - First Name *

Resident 2 - Last Name *

Phone *

Email *

Resident 2 - Phone *

Resident 2 - Email *

Date of birth *

Resident 2 - Date of Birth *

Gender

Male / Female / Other

Male
Female
Other
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Resident 2 - Gender

Male
Female
Other
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How long at this address? *

Resident 2 - How long at this address? *

Reason for leaving current address *

Resident 2 - Reason for leaving current address *

Name of current landlord/agent *

Resident 2 - Name of current landlord/agent *

Telephone number of landlord/agent *

Resident 2 - Telephone number of landlord/agent *

Previous Address

Resident 2 - Previous Address

Reason for leaving previous address

Resident 2 - Reason for leaving previous address

Name of previous landlord/agent

Resident 2 - Name of previous landlord/agent

Telephone number of previous landlord/agent

Resident 2 - Telephone number of previous landlord/agent

Employment Information:

Resident 2 - Employment Status *

Resident 2 - Full time/Part time/Casual/Unemployed

Full time
Part time
Casual
Unemployed
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Job Title:

Resident 2 - Job Title:

Name of employer in Warrnambool - Business name

Warnambool employer

Resident 2 - Name of employer in Warrnambool - Business name

Warnambool employer

Address of employer

Resident 2 - Address of employer

Length of Employment:

Resident 2 - Length of Employment:

Name of contact person

Resident 2 - Name of contact person

Phone number of contact person

Resident 2 - Phone number of contact person

Salary net income per week ($) *

Resident 2 - Salary net income per week ($) *

Other net income per week (e.g. investments) ($)

Other income

Resident 2 - Other net income per week (e.g. investments) ($)

Other income

References:

1. Name of reference *

Resident 2 - 1. Name of reference *

1. Relationship to applicant

Resident 2 - 1. Relationship to applicant

1. Phone number of reference

Resident 2 - 1. Phone number of reference

2. Name of reference *

Resident 2 - 2. Name of reference *

2. Relationship to applicant

Resident 2 - 2. Relationship to applicant

2. Phone number of reference

Resident 2 - 2. Phone number of reference

Date room required from *

Any Additional Comments or Questions?

By checking this box, I declare that the information given on this form is true and correct to the best of my knowledge.

Signature *

Clear

Resident 2 - Signature *

Clear