Quality Living Housing Cooperative

QUALITY LIVING HOUSING COOPERATIVE

3A Europa Private, Nepean, ON K2E 7R5

(613) 226-3406

Email:

For office use only: / □ Cheque □ Money Order
Date received: ______/ Total amount received: $______

Application for Membership

All household residents over the age of 18 must apply for membership to the Co-op. All are responsible for completing the relevant sections of this application and for paying a $25.00 (per applicant) non-refundable application fee (payable by cheque or money order – cash will not be accepted).

In order to provide a self-governing and co-operative community for members, and to keep costs low, all members must make a firm commitment to participation. This means regular attendance at general membership meetings, serving on committees or work parties, and practicing the principles of co-operation in dealing with neighbours and the Co-op as a whole. Unless you are prepared to make a commitment to participate, and to carry it through during the entire time that you are a member, co-op housing is not for you!

Privacy: The information provided in this application is confidential. The only people who will have access to your application are the Co-op's office staff, Board of Directors, and the Membership Committee.

Family Composition

Please list everyone who is applying, including children.

Name / Date of Birth / Gender Identification / Relationship to applicant #1
dd / mm / yyyy
1.
2.
3.
4.
5.
6.
7.

Parking

Number of parking spaces required? ______

(There is a nominal fee for second and additional spaces)

First automobile:
Make/Model: ______
Colour: ______/ Second automobile:
Make/Model: ______
Colour: ______

Do you own any other vehicles that would be parked on Co-op premises?

[snowmobile(s), trailer(s), boat(s), etc.] □Yes □No

If Yes, please specify the type of vehicle: ______

Pet Control

Do you have any pets? □Yes □No

If Yes, please specify: ______

Applicant Information

(All applicants 18 years of age and over must complete pages 4-7. Please print as many copies as needed.)

Surname: ______Given Name(s): ______

(please print) (please print, all names)

Birth Name(s):______(please print)

Current Address: ______

City: ______Province: ______Postal Code: ______

Telephone: Home (____) ______Work (____) ______

Email address: ______

Have you included an application fee of $25.00, paid by cheque or money order (cash will not be accepted) with your application? □Yes □No

Employment Information

Current Employer: ______

Address: ______

City: ______Province: ______Postal Code: ______

Telephone: (____) ______Occupation: ______

Length of employment: Years: ______Months: ______

□ Full Time□ Part Time□ Permanent□ Temporary

Previous employers (for the past 7 years):

NameAddressDates of Employment

______

Accommodation InformationName: ______

At present, do you own □ or rent □ ?

Cost of accommodation: Rent/Monthly mortgage$______

Utilities (heat + hydro)$______

Present Landlord:

Name: ______

Address: ______

Phone: ______

How long have you lived at this address? Years: ______Months: ______

Reason for leaving present accommodation: ______

______

Previous Addresses (please provide for last 5 years):

Name of landlord: ______Phone: ______

Address: ______

Dates of residence: ______

Name of landlord: ______Phone: ______

Address: ______

Dates of residence: ______

Name of landlord: ______Phone: ______

Address: ______

Dates of residence: ______

Volunteer/Participation HistoryName: ______

Have you ever done volunteer work?□ Yes□ No

What kind? ______

For which organization? ______

Length of association with organization: Years: ______Months: ______

What kind? ______

For which organization? ______

Length of association with organization: Years: ______Months: ______

What kind? ______

For which organization? ______

Length of association with organization: Years: ______Months: ______

The following committees are available for participation in the Co-op:

Social and RecreationParticipationFinancePet Control

MaintenanceLandscapingMembershipParking

Please note: It is the responsibility of the individual member to record participation hours and submit these records on a monthly basis to the Participation Committee.

Financial InformationName: ______

Income

Please indicate all income. All income listed must be supported by documentation. For a list of accepted documentation, please see Appendix A.

Annual Income from Employment
(from all employers) / Municipal Welfare / Provincial Family Benefits / Pensions
(Federal, Group, Private, etc.) / Other Sources
(Please specify – i.e.: child support)
Totals:

Financial Obligations

Please list all outstanding debts and similar commitments. A credit check will be performed as part of the application review process.

Creditor / Type of Loan / Original Amount / Amount Still Owing / Monthly Payment
Totals:

I/We understand that only members of Quality Living Housing Co-operative Inc. may occupy a housing unit and I/we understand that membership includes the responsibility to participate in the operation and maintenance of the Co-op.

I/We declare that all information in this application is correct and hereby authorize Quality Living Housing Co-operative Inc. to make any enquiries that may be necessary in order to verify the statements contained in this application. I/We authorize the Quality Living Housing Co-operative Inc. to perform any financial checks it deems necessary. Should any information included in this application be found to be false, I/we understand that this is grounds for termination of the application.

______

(Print and sign name)(date)

______

(Print and sign name)(date)

______

(Print and sign name)(date)

______

(Print and sign name)(date)

______

(Print and sign name)(date)

Thank you for your interest in Quality Living Housing Co-operative.

The application and interview process typically takes four to six weeks from the time we receive your complete application, including all required fees, documents, and information.

The information provided in this application is confidential. The only people who will have access to your application are the Co-op's office staff, Board of Directors, and the Membership Committee.

Appendix A – Documentation Required for Income Verification

Quality Living Housing Co-operative needs to verify your source of income to ensure that you can make your financial obligations to the monthly Housing Charge.

Regularly Employed (full time, part time, or casual)

Submit confirmation letter(s) from your employer(s) stating gross wages and hours or annual salary, as well as employment status. Letter should be printed on company letterhead and include a signature. Letter for part time employees should include minimum/maximum hours. Submit originals only. Photocopies will not be accepted.
Note: T4 slips or income tax returns are not acceptable documentation by themselves.

Irregularly or seasonally employed

Submit a confirmation letter from your current employer or a copy of your employment insurance warrant statement, as well as your last Notice of Assessment. If providing a letter from your current employer, this must be printed on company letterhead and include hourly wage and working arrangement (such as minimum hours or months of employment).

Unemployed, receiving EI payments

Submit a copy of your employment insurance warrant statement.

Government Assistance

Submit letter(s) from the agencies from which you receive benefits: DVA (Department of Veteran Affairs), Worker's Insurance System, Worker's Compensation, Social Assistance. Letter must set out benefits received.
Note: A copy of your benefit cheque is not sufficient documentation by itself.

Pension

Submit proof of your most current pension benefits, which could include:
OAS (Old Age Security)
GIS (Guaranteed Income Supplement)
CPP (Canada Pension Plan)
Or private pensions, Worker's Insurance System, etc.

Self-Employed

Submit a letter of financial assessment from a chartered accountant and/or most recent Notice of Assessment.

Support Payments Received

Submit agreement of alimony, separation, or support payments. The amounts listed must be verified with legal documents, or a letter, from the Family Court or a lawyer.

Rental Income

Submit copies of cheques or written agreements made if you have rental property that you own, such as a summer cottage.

Income Yielding Asset or Investments

Submit statements or tax forms relating to dividends or interest paid on stock/investment papers, savings accounts, bonds, debentures, bank deposits, or notes, trust accounts, credit unions, mortgage or loans, if the level of incomes exceeds $2,000.00.

Note: All income must be reported, including the following:

Part-time earnings, commissions, tips and gratuities, earnings from home child care, housework, etc.

Every adult member of your household, plus every child over the age of 18 not attending school full-time, must declare his or her income.

April, 2017