Apply for housing

Before you start

If you need help completing this form please contact 01900 602906.

All information will be treated in confidence.

This document can be provided in large print, audio format and other languages if required.

Your Details

Date of birth

Is there a joint applicant?

Joint Applicant Details

Date of birth

Have you been a tenant of this Association before?

Have you, or the joint applicant, ever been evicted by a landlord before?

Do you, or the joint applicant, owe any rent arrears or recharges to any landlord?

Do you have a payment plan in place?

Current Household Details

Please give details of all people in your current household even if they won’t be moving with you.

Don’t include yourself or the joint applicant.

You should be aware that the Association has very few 4 bedroom properties.

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Date of birth

Is this person moving with you?

Address history

Please give detail of anywhere else you have lived in the last 5 years not including your current accommodation.

Current tenancy details and accommodation

In your current accommodation, are you?

What type of property do you currently live in?

How many bedrooms are there?

Current circumstances

Have you approached your local authority for help with homelessness?

Were you given:

Why must you leave your current accommodation?

Are you or your joint applicant currently serving or have ever served in the armed forces?

Health and Disability

If anyone to be re-housed has an illness or disability, please give details:

Have you approached your current landlord for help with moving?

Have you registered with Cumbria Choice?

What type of property do you need?

Property type

Do you require a specially adapted accommodation?

Where do you want to live?

Please list the schemes/areas for which you wish to be considered. (See Our Homes on our website).

How many bedrooms do you need?

Do you have any pets such as a cat or dog?
(this may not affect your offer of housing)

Support Agencies

Criminal Activity

Do you or anyone else moving with you have any convictions?

Have you or anyone moving with you been charged with any offences which are yet to be dealt with by the court?

Are you or anyone moving with you on the Sex Offenders Register?

Income Details

Please give details of income and benefits for yourself, your partner and other relevant household member.

Current employment

Please add details of any person working in your household:

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Type of employment

Are you or your partner in receipt of benefits/Universal Credit?

Pensions and benefits

Please provide details of any benefits or pensions you are currently receiving

Employee / Member

Are you or your partner an employee or member of the Association, or a relative of any employee or member?

If you are successfully shortlisted for a property we will make an appointment to visit you at home to complete a pre-tenancy assessment sheet. During this interview we will ask for the details of the person providing your reference and for two forms of identification documents which is in line with the government right to rent criteria as listed below.

These documents must be original copies of one item from list A or two from list B.

List A

  • Passport
  • EEA Identity Card
  • UK Permanent Resident Card
  • Certificate of naturalisation registration of British Citizen
  • UK immigration Status document with unlimited leave
  • Biometric Residence Permit with Unlimited Leave
  • Passport or travel document with unlimited leave

List B

  • Birth or Adoption Certificate
  • Full or Provisional Driving License
  • Letter from UK Government/local authority
  • Benefits paperwork
  • Letter from HM Prison
  • Letter of attestation from an employer
  • Utilities Bill
  • Evidence of service in UK forces
Additional Information

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Declaration Statement

I understand that Westfield Housing Association will process and retain the information provided on this form in accordance with the General Data Protection Regulations.

For further information on how we use your information and how we obtain a copy of the information held about you, please go to www.westfieldha.org.uk/page/privacy or write to Data Protection, Westfield Housing Association, Minto Centre, Nilsson Drive, Westfield, Workington, Cumbria, CA14 5BD (dataprotection@westfieldha.org.uk).

I/we authorise Westfield Housing Association to obtain information and/or evidence from any third party, including:

  • All other Social Landlords
  • Local Authority (housing benefit, Universal Credit and council tax queries)
  • Utility Companies
  • Social Services
  • Police
  • Next of Kin as listed above and/or Support Worker

I/we also authorise Westfield Housing Association to provide information to third parties that may reasonably request information relating to my/our tenancy.

I/we authorise the disclosure of relevant personal information to Westfield Housing Association in connection with my housing arrangements, my finances or my housing benefit & Universal Credit entitlement.

The information I have given on this application is accurate to the best of my knowledge and I agree to let Westfield Housing know of any changes to my circumstances.

Please note under the Housing Act 1999 Part 6, it is a criminal offence to knowingly give false information or withhold information in respect of any matter relating to your application.

Applicant signature (and joint applicant if applicable)