A1 Level 1 : Learning activity 3 : Stage 31

MOVING TO A NEW PLACE

Home earch application form
Please write the first or main applicants surname here
Important: Please make sure you read all the information presented in this
document carefully before you complete this form.

A. Your details
First name(s)
Give any other name(s)
you were previously known by
Date of birth
For example 06/12/1968
Current address
Postcode
Contact/corresponde
nce or safe address
(if

different

above)
Contact
telephone
numbers(s)

Email address

from

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

Do you experience
difficulties

Yes

No

with reading or writing?

Mal
e

Whats your gender?

What is your religion?

Prefer not to
say
Muslim Sikh

Female
Buddhis
t
Christia
n

Hindu

None

Other

Jewish
(please
specify)

B. Employment information
If you are working, please tell
us:

N
o

Yes

What do you do?

C. Your family or household

We need to know if other people will be moving with you. This will help us to know
what type of home you will need. Please give their details below.
1st
Last name
First name
Date of birth
Gender
Relationship
to you
(wife,
son,
etc.)

2nd

3rd

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

D. Your present accommodation/circumstances

Tick the box against the property type in which you live or best describes your
circumstances.

Hous
e

Trailer

Host
al

Flat/apartment

condominium

Hote
l

Bungalow

Cottage

Terraced house

Detached house

Semi-detached house

No fixed address

E. Your house preferences

State your house preferences describing all the characteristics you want your new
home to have.

House type (apartment, cottage, etc.)

Number of rooms
Number of bathrooms
Which floor (if located in a building)
Public utilities (gas, water, etc.)
Location
Price

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

F. Special requirements
Write a more detailed description of the kind of house you want to have.

G. Applicants signature
Name
Date

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.