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 941Room Number 942Room Number 15aRoom Number 22Room Number 50Room Number lobby room 1Room Number 52Room Number 56Room Number 59Email* 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 $485 per week$486 to $775 per week$776 to $1,163 per week$1,164 and above per weekIncome Level: Affordable Accom actively seeks tenants on low incomes to support affordable accommodation opportunities in the community. 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