Application Form For Transitional Housing Page 4
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73.2b Previous Employment Information
Business/Employer Name
Length of Employment
Years
_____
Months
_____
3.2c Training Information
Full time
Part Time
Name of College/Institution
Length of Training Qualification
Years
_____
Months
_____
Completion Date of Training Qualification
(dd/mm/yyyy)
Contact Name
Phone/Mobile
PART 4 – FINANCES
PART 4.1 APPLICANT INCOME AND ASSETS
If the amount is nil write ‘Nil’ . If the amount is an estimate write ‘E’ before the amount.
4.1a Salary or wages
Are you self-employed?
Yes
No
What is your total average gross weekly salary (before tax)?
4.1b Gross Investment Income (E.g. Rental property, shares, etc)
Income Type
Paid By
Average Weekly Total
4.1c Income from Business / Partnership / Company / Trust
Business Name
Business Type
Average Weekly Total
4.1d Government Benefits (E.g. Centrelink, pension)
Benefit Type
Average Gross Weekly Total
4.1e Child Support Payments (maintenance payments for child, not Centrelink payments)
Paid By
For the Benefit of
Amount Paid
Amount Received
4.1f Other Income
Paid by
Income Type
Average Weekly Total
PART 4.2 OTHER HOUSEHOLD INCOME EARNERS
Name
Age
Relationship to you
Average weekly total
PART 4.3 DEBT (if relevant)
4.3a Loans
Name of Lender
Full name of borrowers
Amount owed
4.3b Credit Cards / Charge Cards
Card Provider and Type
Amount you owe
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