THIS IS NOT AN ON-LINE APPLICATION - PLEASE PRINT AND RETURN WITH YOU $15 PER ADULT MEMBERSHIP FEE
William Peak Co-operative Homes Inc. 1990 Whites Road, Pickering ON L1V 6P5
PH: (905) 837-2920 FAX: (905) 837-2922 EMAIL: williampeakboard@yahoo.ca
HOUSING APPLICATION FORM
All reference and financial information will be kept confidential and will be used only by Co-op staff to evaluate your request for membership.
1. HOUSEHOLD COMPOSITION
Applicant #1:
Name: _______________________________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________
Home Phone: __________________________ Work Phone: _________________________
Applicant #2:
Name: _______________________________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________
Home Phone: __________________________ Work Phone: _________________________
Applicant #3:
Name: _______________________________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________
Home Phone: __________________________ Work Phone: _________________________
Other Members:
Name Relationship to Applicant #1 Birthdate
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Pets: ________________________________________________________________________________
List pet’s breed, age, and description
2. WORK HISTORY
Applicant #1
Employer: ______________________________
Address: ________________________________
_________________________________
Phone: _________________________________
Occupation: _____________________________
Length time employed: ____________________
Applicant #2
Employer: ______________________________
Address: ________________________________
_________________________________
Phone: _________________________________
Occupation: _____________________________
Length time employed: ____________________
Applicant #3
Employer: ______________________________
Address: ________________________________
_________________________________
Phone: _________________________________
Occupation: _____________________________
Length time employed: ____________________
3. ACCOMMODATION HISTORY
If the information requested below is not the same for each applicant, please provide additional information concerning each adult on a separate sheet.
a) Do you rent your present dwelling? ____________
b) If yes, what is your monthly rent? ____________
c) Landlord’s Name: ____________________________________ Phone: ____________________
May present landlord be used as a reference? ____________
If no, please explain why not: ______________________________________________________
______________________________________________________________________________
d) Do you own your present dwelling? ____________
e) If yes, what is your monthly mortgage? ____________
4. HOUSING REQUIREMENTS
One Bedroom Apartment (Seniors Only): ____________
One Bedroom Modified Apartment (Seniors Only): ____________
Two Bedroom Apartment (Seniors Only): ____________
Two Bedroom Modified Apartment (Seniors Only): ____________
Two Bedroom Townhouse Unit: ____________
Three Bedroom Townhouse Unit: ____________
Four Bedroom Townhouse Unit: ____________
Number of Vehicles: ____________
Does any member of your household have health problems or concerns that affect their housing needs? If yes, please specify: _____________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
5. PARTICIPATION
All Co-op members are expected to volunteer some time to help with the running of the Co-op. Please specify the area of interest for each applicant by noting first and second preferences with each applicant initialing their choices.
Social Committee ____________
Children’s Committee ____________
Maintenance Committee ____________
Seniors’ Committee ____________
Board of Directors ____________
Other Volunteer Activities: (Specify) ______________________________________________________
Why are you particularly interested in this committee or volunteer activity? ________________________
_____________________________________________________________________________________
6. GENERAL INFORMATION
How did you hear about William Peak Co-operative Homes Inc.? ________________________________
_____________________________________________________________________________________
Have you lived in a housing Co-op before, or been involved in any other form of Co-op or Credit Union?
If yes, give details: _____________________________________________________________________
Have you ever been involved with any other volunteer organizations such as a community group, service club or trade union? If yes, give details: ____________________________________________________
_____________________________________________________________________________________
7. INCOME INFORMATION
Applicant #1
Birth Date: ___________________
Social Insurance No. ___________________
Bank/Credit Union: ______________________
Gross monthly employment income: _____________
Income from other sources: ____________________
Applicant #2
Birth Date: ____________________
Social Insurance No.: ____________________
Bank/Credit Union: ________________________
Gross monthly employment income: ______________
Income from other sources: ____________________
Applicant #3
Birth Date: ____________________
Social Insurance No.: ____________________
Bank/Credit Union: ________________________
Gross monthly employment income: ______________
Income from other sources: ____________________
Total Household Gross Income per Month: $ _______________
If there are more than three people receiving an income, list additional information on a separate page.
Please attach proof of income (paystubs, etc.) to this application.
If you are aware of any credit problems that may affect your credit reference, please provide all information that may assist the Co-op with your credit history.
_____________________________________________________________________________________
I/We understand that only members of the Housing Co-operative may occupy a housing suite and I/we hereby apply for membership in the co-operative.
I/We understand that this application must be accompanied by the following:
• Fifteen dollars ($15.00) non-refundable application fee per adult applicant.
• Proof of income in a form acceptable to the Co-operative for each member of the household who receives an income.
I/We understand that moving into the Co-operative depends on being accepted for membership in the Co-operative and that I/we may be interviewed before our application is approved.
I/We understand that living in a unit in the Co-operative will depend on my/our signing a legal agreement with the Co-operative, and that before I/we move in, I/we will have to pay the first month’s housing charge and to pay the member’s deposit (this is not your last months housing charge).
I/We declare that all the information in this application is correct and hereby authorize the Co-operative to verify any or all of the information contained herein, and to perform a credit check at the discretion of the Co-operative.
(For townhomes only)
I/We understand that if accepted for membership and occupancy at William Peak Co-operative Homes Iwe are responsible for setting up heat and hydro accounts before move-in and providing the account numbers to the Co-op office.
Applicant #1 Signature: ______________________________________ Date: _____________________
Applicant #2 Signature: ______________________________________ Date: _____________________
Applicant #3 Signature: ______________________________________ Date: _____________________