West Harris Crofting Trust

CONFIDENTIAL WHEN COMPLETE

APPLICATION FOR PROVISIONAL AWARD OF HOUSE SITE

Please complete all sections. Should you run out of space for your answer, use the continuation sheet provided. Please type or print legibly in blue or black ink.

1.Site.

The Trust is offering sites for sale, in Horgabost, and Luskentyre. Please rank your favoured locations with a 1 or 2. (Leave blank if 1 location not desired):

Luskentyre:
Horgabost:

2.Personal Details (Applicant).

Surname: / Forename(s):
Date of Birth:
Address:
Postcode:
Telephone: / (Home) / (preferred) / (Mobile)
Email:

3.Personal Details (Family).

Name and address (if different) of spouse, civil partner, or partner.
Surname: / Forename(s):
Date of Birth:
Address:
Postcode:
Details of any children under the age of 18 and ordinarily resident with the applicant:
Name: / Name:
Date of Birth: / Date of Birth:
Name: / Name:
Date of Birth: / Date of Birth:
Name: / Name:
Date of Birth: / Date of Birth:

4.Employment.

A – Present or Most Recent Employment
Employer: / Post:
Length of Service:
Industry:
B – Anticipated Future Employment
If not already employed in the local area, please outline your anticipated future employment in Harris should your application be successful.
(i) Applicant
Anticipated Employer and/or Industry:
Anticipated Post:
Is Employment Confirmed? / No
(ii) Spouse, Civil Partner, or Partner
Anticipated Employer and/or Industry:
Anticipated Post:
Is Employment Confirmed? / Yes / No
C – Self-Employment/Business Plans
If you intend to take up self-employment or to start a business, please outline your proposed plans below. The Housing Panel will wish to consider the viability of your plan in light of local circumstances, therefore you may wish to submit a more detailed Business Plan with this application.
(i) Applicant
Nature of Proposed Business:
Number of Employees:
General Description:
(ii) Spouse, Civil Partner, or Partner
Nature of Proposed Business:
Number of Employees:
General Description:

5.Education.

A - Educational Attainment
Please indicate your highest level of educational attainment and that of your spouse (if applicable).
Applicant: / Spouse:
Secondary Education:
Bachelors Degree:
Other Higher Education:
Masters Degree/Doctoral Degree:
Other Postgraduate:
B–School Placement
Please indicate your intended school placement for any children of school age:
Name: / Name:
Placement: / Placement:
Name: / Name:
Placement: / Placement:
Name: / Name:
Placement: / Placement:

6.Rural Experience.

Please indicate your experience of life on Harris or other rural environments along with that of your spouse (if appropriate).
Applicant: / Spouse:
Born or brought up in Harris: / Length of Service:
Born or brought up in Hebrides
Resident in Western Isles for more than 12 months:
Experience of living in a small rural community:
If you wish, you may provide any further pertinent information on your experience and knowledge of rural life:
Details:

7.References.

Please name two referees.
Name: / Name:
Address: / Address:
Postcode: / Postcode:
Occupation: / Occupation:
Telephone: / Telephone:
Length of Time Known: / Length of Time Known:

8.General Information.

A – Relationship
Please indicate any family relationship to current Directors or Employees of the Trust. This will not affect your allocation opportunity.
Name / Relationship
B – Criminal Convictions
Do you have any criminal convictions or cautions which are not regarded as ‘spent’ under the Rehabilitation of Offenders Act 1974?
(Delete as appropriate)
Details:

7.Statement.

If you wish you may provide any additional information which you think will support your application, whether in reference to the questions above or more generally in terms of skills, suitability etc.
Please use this space and, if needed, continue on anothersheet of paper. Please restrict yourself to no more than two extra sides of A4.
.

8.Declaration.

I declare that the information given on this application form is to the best of my knowledge true and complete. I understand that the Trust reserved the right to verify all claims made in this application.
Signed: / Date:

Please return all completed applications to:

The West Harris Trust

Talla na Mara

Pairc Niseaboist
Isle of Harris

HS3 3AE