Aaron Webster Co-Op Application

Please return to:

Membership Committee / #108 – 1885 Pender St. East / Vancouver, B.C. V5L 1W6

The information contained in this application is completely confidential

and will be used only for purposes of selecting new Aaron Webster Co-op Members.

q Please tell us about you:

	APPLICANT A	APPLICANT B
NAME
HOME / WORK PHONE NUMBERS	/	/
DATE OF BIRTH
CURRENT ADDRESS
CITY AND POSTAL CODE
E-MAIL ADDRESS

q How did you hear about Aaron Webster Co-op? ________________________________

( If newspaper ad, which newspaper? )

q Who will be living with you?

FIRST AND LAST NAMES

DATE OF BIRTH

RELATIONSHIP

q HOW MANY BEDROOMS DO YOU NEED? ______ 1 ______ 2 ______ 3

(We encourage families, two or more people living together, to apply for the 2 and 3 bedroom units.)

q DO YOU HAVE PETS? ____ HOW MANY? ____ WHAT KIND(S)? ______________________

q DO YOU NEED A PARKING SPACE? ________ (All vehicles must have valid insurance.)

q DO YOU HAVE ANY SPECIAL NEEDS? (Disabilities, allergies, phobias, etc.)

______________________________________________________________________________

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q Please describe your volunteer experience and community participation INCLUDING organizations, roles, tasks and goals:

______________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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q PLEASE LIST TWO REFERENCES FOR EACH APPLICANT WHOM WE MAY CONTACT. AT LEAST ONE MUST BE SOMEONE THE APPLICANT HAS WORKED WITH IN HER / HIS VOLUNTEER EXPERIENCE. LIST ADDITIONAL REFERENCES ON A SEPARATE SHEET.

	APPLICANT A	APPLICANT B
1. FIRST AND LAST NAME
HOME PHONE
WORK PHONE
2. FIRST AND LAST NAME
HOME PHONE
WORK PHONE

q Briefly list the skills with which you could contribute to Aaron Webster Coop

(e.g., home improvement, arts & crafts, workshop facilitation, hobbies):

APPLICANT A

APPLICANT B

q Please explain why you would be a suitable Member and

how you could contribute to the community life of Aaron Webster Co-op:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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q Your present living arrangements:

	APPLICANT A	APPLICANT B
NAME OF PRESENT LANDOWNER
ADDRESS
PHONE NUMBER
RESIDENT FROM ( DATE )
TO ( DATE )
If less than 2 years at the address listed above, where did you live before?
NAME OF PREVIOUS LANDOWNER
ADDRESS
PHONE NUMBER
RESIDENT FROM ( DATE )
TO ( DATE )

q May we contact your current / previous landowner (s)? Yes ___ No ___

q Your current rent? $_______ per _____ Includes utilities? Yes ___ No ___

q Employment:

	APPLICANT A	APPLICANT B
OCCUPATION / TITLE or TRADE / POSITION
FROM ( DATE ) TO ( DATE )
EMPLOYER’S NAME
ADDRESS
PHONE NUMBER

q Additional sources of income:

APPLICANT A

APPLICANT B

q Annual income before tax:

APPLICANT A	APPLICANT B
$	$

Applicants are required to bring income verification (pay stubs or other) to any interview.

q Are you able to provide income verification? Yes _______ No ________

q Please read and sign below:

I confirm that all the information contained in this Application is accurate. I hereby authorize the Members of Aaron Webster Housing Co-op to obtain such credit reports, references from landowner (s), confirmation of employment and other information from sources named above as may be deemed necessary in connection with the establishment and maintenance of my Society Membership Account. This consent is given pursuant to Section 12 of the Personal Information Reporting Act, S.B.C., 1973.

Note: Following an interview your permission may be asked to perform a Credit Report.

____________________________________ ____________________________________

Signature of Applicant A Signature of Applicant B

Signed in ____________________________, _______ on __________________________

(City) (Province) (Month) (Day) (Year)

K Applications more than one (1) year old will be discarded unless we hear from you. please inform us, in writing, if you do or do not wish to remain on our waiting list, and of any changes to the information in this application.

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OFFICE USE ONLY

Date application received: _______________________________________________________

Date of interview: _____________________________________________________________

Results of interview: ____________________________________________________________

RECORD OF CALLS MADE TO APPLICANT (S):

DATE

YOUR NAME

REASON FOR CALL

APPLICANT COMMENTS

YOUR COMMENTS