201-424 Logan Ave,
Wpg. Man. R3A 0R4
TEL 956-5093 FAX 943-0226
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
Date: ______
Applicants full name: ______
first middle last
maiden name: ______
Spouses full name: ______
first middle last
maiden name: ______
Phone # ______or leave message at ______
Present address : ______How Long? ______
Present landlord : ______Phone Number ______
Size of family ______# of persons Size of unit requested ______# of bedrooms
Check () which area you would prefer to live: limit 3
1 Central 2 North End 3 Maples 4 East Kildonan 5 Fort Rouge
6 West End 7 Point Douglas 8 Tyndall Park 9 Transcona 10 River Heights
11 Weston 12 Garden Grove 13 West Kildonan 14 Elmwood 15 Anywhere
Are you working: ______Are you on Social Assistance: ______Student Assistance: _____
Name of Worker: ______Case Number: ______
What office: ______Telephone: ______
Two of the following are required:
Manitoba Medical Number ______Social Insurance Number ______
Driver=s Licence Number ______Credit Card Number ______
I declare that I and/ or my legal dependants are of aboriginal ancestry, being :
Status , Non-Status , Metis , Inuit . (check one )
______
signature of applicant
Please provide the following information regarding yourself and family.
Name Date of Birth Relationship Monthly Income
______
You will be required to provide proof of custody, guardianship, or confirmation by CFS of foster children.
Please read carefully: details of income received by you and any member of the family living with you MUST BE REPORTED. Income from salaries, wages, pensions, employment insurance, sick benefits, compensation, commissions, fees, agreements, part time etc... Must be reported in full DO NOT REPORT CHILD TAX CREDIT
Monthly rent at present address: ______How many bedrooms ______
Does it include: Heat Hydro Water Fridge Stove
Furnished Unfurnished
Please state reason for applying to for Urban Native Subsidized Housing? Check the following that apply:
Cannot afford present rent; House too small/big
House in bad need of repairs Area not suitable
Other ______
Please list other reasons you feel may help with your application:______
THE FOLLOWING MUST BE COMPLETED BEFORE YOUR APPLICATION WILL BE PROCESSED!
Previous addresses ( last 3 years ) Please provide Name and Telephone numbers of Landlords.
1. ______from ______to ______
landlord name ______telephone ______
Do you have a lease?______Is notice required? ______How much notice ? ______
2. ______from ______to ______
landlord name ______telephone ______
3.______from ______to ______
landlord name ______telephone ______
Name and Address of Employer From - To Position Reference
______
Credit references: Bank, Rentals, etc.
______
Have you or your spouse ever rented from Kinew Housing?
What address? ______
In case of emergency, whom could we contact ( we must have a contact person)
Name: ______Address: ______
Telephone: ______What relationship: ______
I/We hereby declare that the foregoing information is true and complete. I/We understand that any false information may result in the refusal of My/Our application. I/We hereby consent to a reference check, credit check and personal investigation.
______
Applicant Signature Applicant Signature Housing Representative
Your application will be filed and processed as soon as possible. Due to the amount of applications that we receive it may be as long as six months before we contact you regarding your application. Please do not call before the six months, unless you have changed your phone number. Your application will be kept on file for two years, it is important that you keep your phone number current in order for us to reach you, Please make sure that you have completed all of your application.
Office use only ------this area not to be completed by Applicant ------Ref 1 / Ref 2 / Ref 3
Person contacted.
Length of tenancy
Late rent ? / Yes No / Yes No / Yes No
How often?
Monies outstanding ? / Yes No / Yes No / Yes No
How much?
Noise and disturbance complaints ? / Yes No / Yes No / Yes No
Proper notice given? / Yes No / Yes No / Yes No
How much notice required ?
What was condition of unit ?
Was deposit returned? / Yes No / Yes No / Yes No
Did you serve notice of termination ? / Yes No / Yes No / Yes No
Why?
Would you rent to this tenant again ? / Yes No / Yes No / Yes No
Notes:
* You are also encouraged to apply on-line at www.munha.ca *
THERE IS A NO PET POLICY, NO PETS ARE ALLOWED IN HOUSES OR APARTMENT
NOTICE OF INCOME TAX ASSESSMENT
MUST ACCOMPANY APPLICATION !
Canada Revenue Agency 1-800-959-8281