China Creek Housing Co-operative

600-1230 East 8th Avenue, Vancouver, BC, V5T 1V2 Telephone/Fax: 604-876-4286

FOR OFFICE USE ONLY

Date Received:
# of Bedrooms: / 1st: / 2nd:
Financial: / Market / Subsidy / Notes:
Contact: / Date: / Notes:
Interview Scheduled: / Date: / Notes:

APPLICATION FORM

(Please print)

TODAY’S DATE: ______

I. PRIMARY APPLICANT

NAME: ______

(first) (last)

CURRENT ADDRESS: ______

(apt. #, street)

______

(city/province) (postal code)

TELEPHONE: ______

(home) (cell)

EMAIL ADDRESS: ______

PREVIOUS ADDRESSES: (last five years)

1. ______

2. ______

3. ______

II.  OTHER APPLICANTS RESIDING WITH YOU

ADULT’S NAME: ______

(First) (last)

RELATIONSHIP TO YOU:______

ADULT’S NAME: ______

(first) (last)

RELATIONSHIP TO YOU:______

CHILDREN RESIDING WITH YOU:

Name / Date of Birth (mm/dd/yyyy) / Part-time or Full-time
1.
2.
3.

PETS: YES/NO (please circle)

If yes, How many:______What kind: ______

III.  HOUSING NEEDS

PLEASE INDICATE 1ST, 2ND PREFERENCE (if applicable):

____ 1 Bedroom ____ 3 Bdrm Apt/Townhouse

____ 2 Bedroom ____ 4 Bdrm Townhouse

DO YOU REQUIRE A PARKING STALL? YES/NO (please circle)

DO YOU REQUIRE ANY OF THE FOLLOWING:

____ Live in Attendant ____ Grab bars

____ Wheelchair ____ Adapted Kitchen

IV.  EMPLOYMENT INFORMATION

PRIMARY APPLICANT’S EMPLOYMENT (last five years):

1. Employer:
Reference:
Reference Title:
Telephone:
2. Employer:
Reference:
Reference Title:
Telephone:
3. Employer:
Reference:
Reference Title:
Telephone:

OTHER ADULT APPLICANT’S EMPLOYMENT (last five years):

1. Employer:
Reference:
Reference Title:
Telephone:
2. Employer:
Reference:
Reference Title:
Telephone:
3. Employer:
Reference:
Reference Title:
Telephone:

V.  HOUSING REFERENCES

I GIVE CHINA CREEK CO-OP CONSENT TO CONTACT MY PRESENT LANDLORD: YES/ NO (please circle)

PRESENT LANDLORD:______

(Name) (Telephone #)

VI.  QUESTIONNAIRE

ITEMIZE ANY PAST VOLUNTEER WORK (most recent):

______

HAVE YOU HAD ANY EXPERIENCE WITH CO-OPS OF ANY KIND? YES/NO

WHAT TYPE? ______

______

______

DO YOU HAVE ANY SPECIAL SKILLS OR INTERESTS THAT MAY BE HELPFUL IN RUNNING A CO-OP? IF YES, PLEASE EXPLAIN:

______

ARE THERE ANY REASONS THAT YOU WOULD NOT BE ABLE TO CONTRIBUTE TO A CO-OP?: ______

______

WHICH COMMITTEES WOULD YOU BE PREPARED TO SERVE ON:

____ Newsletter / ____ Security/Perimeter
____ Maintenance / ____Social
____ Membership / ____ Board of Directors

HOW DID YOU HEAR ABOUT CHINA CREEK CO OP? ______

______

DO YOU KNOW ANYONE CURRENTLY RESIDING AT CCC? YES/NO

IF YES, PLEASE GIVE THEIR NAMES______

______

VII.  INCOME VERIFICATION

ANNUAL GROSS INCOME
Primary Applicant: / $______/ yr
Other Adults: / $______/yr

Note: China Creek Co-op recommends that the housing payment not exceed 30% of total household income. Housing charges listed at www.chinacreek.ca. We are currently NOT accepting applications for subsidies.

CURRENTLY RECEIVING SOCIAL ASSISTANCE (SA) OR EI? Yes / No

DETAILS: ______

*NOTE: PLEASE INCLUDE 3 CONSECUTIVE RECENT PAYSTUBS WITH APPLICATION. SIN #s, DATE OF BIRTH, AND COPIES OF PREVIOUS YEAR’S T4 SLIPS WILL BE REQUESTED AT TIME OF INTERVIEW.

VIII.  AUTHORIZATION

I/WE UNDERSTAND THAT MEMBERSHIP IN CHINA CREEK CO-OPERATIVE WILL REQUIRE PARTICIPATION OF A MINIMUM OF TEN HOURS PER MONTH PER ADULT, INCLUDING COMMITTEE AND CHORE DUTIES.

I/WE HEREBY ACKNOWLEDGE THAT OUR SIGNATURES ON THIS APPLICATION WILL BE CONSIDERED AS AUTHORIZATION TO MAKE NECESSARY FINANCIAL INQUIRIES (INCLUDING CREDIT CHECKS).

Primary Applicant’s Signature:______Date:______

Other Adult’s Signature: ______Date:______

*PLEASE NOTE: Your application will be kept on file for TWO YEARS only, after which time it will be confidentially disposed of. Please submit a new application at this time, with reference to the old application.

THANK YOU.

CHINA CREEK CO-OP

COMPLETED APPLICATIONS CAN BE DELIVERED ELECTRONICALLY TO:

OR MAILED TO:

China Creek Co-op

600-1230 East 8th Avenue

Vancouver, BC V5T 1V2