Apply Online Name* First Last Post Title* Gender-- PLEASE SELECT --FemaleMaleDate of birth* DD slash MM slash YYYY Start Date Preferred DD slash MM slash YYYY Finish Date Preferred DD slash MM slash YYYY House and Room applying for*-- PLEASE SELECT A HOUSE --958 Dandenong Rd960 Dandenong RdDandenong rd*-- PLEASE SELECT A ROOM --Room Number 922Room Number 942Room Number 52Email* Phone*Country of Origin*-- PLEASE SELECT --AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCity of Origin*Do you have a disability which requires disabled access?* No Yes This field is hidden when viewing the formDisability Requirements Yes No Income Level*-- PLEASE SELECT --0 to $590 per week$591 to $942 per week$943 to $1,414 per week$1,415 and above per weekIncome Level: This should be the income you will earn from the start of your stay and not past earning levels. Affordable Accom actively seeks residents on low incomes to support affordable accommodation opportunities in the community. We actively seek residents who are in the lower bracket of income.Any General Comments? Agreements You will need to first view the document by clicking on each link before you can tick the boxs to proceed with your application. Please save or email a copy of these documents for your records. If you have difficulty opening or viewing any of these documents please contact us - info@affordableaccom.com.au* I have received a copy and agree to the House Rules and Terms and Conditions * I have received a copy and agree to the House Rules and Terms and Conditions * I have received a copy and agree to smoke detector testing * I confirm I have received a copy of the Renters Guide * I confirm I have received a copy of the Renters Guide * I confirm I have received a copy of a Statement of information for rental applicants * I confirm I have received a copy of Rooming houses: a guide for residents and operators * I confirm I have received a copy of Rights and duties of a rooming house resident * I confirm I have received a copy of a Statement of information for Rooming House residents * I confirm I have received a copy of the Notice to prospective rooming house resident - Exclusive occupancy