Pre-application questions

Initial questions
As you already have a housing register application you do not need to answer any pre-application questions, please continue
to the next section.

National Insurance Number Checker

National Insurance Check

Primary Applicant Details

Applicant Details

Primary household member details

Primary Applicant Details

Title*
Mr

First name*
Stephen

Family name*
Keirle

Have you been known by any other names?

not entered

Date of birth*
27/05/1956

National insurance number*

YX395365D

Employment Status*
Working: 30 hours a week or more

We are asking the following questions as part of our public sector equality duty under The Equality Act 2010 for monitoring
purposes and they will not affect you application

Gender*
Male

Marital status*
Single

Do you have a disability?

No

Disability details
not entered

Ethnic origin*
White British

If other, please specify

not entered

Religion*
None

If other, please specify

not entered

Sexual orientation*
Heterosexual / Straight
If other, please specify
not entered

Contact Details

Work telephone
not entered

Home telephone
01344 560814

Mobile telephone
07787882731

Email
not entered

Other Details

Are you pregnant?*

No

If yes, when is the baby due?

not entered

Do you or any of your household have a pet?*

No

Give details
not entered

Do you or any of your household have a live in carer?*

No

Would you like future correspondence in

not selected

Would you like help to use Choice Based Lettings or help to bid for properties*
No

Your Citizenship

Nationality*
UK national habitually resident in UK

How long have you lived in the country? (yrs)*

over 5 years

Are you, or anyone named in this application subject to Immigration Control under the Asylum & Immigration Act 1996?*
No

Have you, or any person named on this application, applied for or been granted asylum / refugee status?*
No

Have you, or any person named on this application, been granted exceptional leave to remain in the United Kingdom?*
No

Have you, or any person named on this application been given leave to enter the United Kingdom for the purpose of
studying at a university or college?*
No

Do you, or any other person named on this application, have access to or own any accommodation elsewhere in the world?
*
No

Correspondence Details

Correspondence Email
stevekeirle@hotmail.co.uk

Correspondence Mobile
447787882731

Current Address Details

Current Address
22 Coppice Green Bracknell Berkshire RG42 1TL
Date you moved in to this address:01/09/2017
Landlord Details
John Frost 22 Coppice GreenbrBracknellbrRG42 1TL

Correspondence Address
Correspondence description:Home
22 Coppice Green Bracknell Berkshire RG42 1TL

Joint Applicant and Other Household Member

Details
Joint Applicant and Other Household Member Details

Address History
Your Previous Addresses
Please give details of all the applicant and joint applicant's previous addresses for the last 10 years.
l Enter the address details
l Tick the box next to name of household member who lived at this address
l Fill in the date fields and Landlord information
l Click the save button
l When all addresses are entered and show in the table below, click on the Next Section buttons

Mr Stephen Keirle (Primary applicant)

1
Current address Date lived at address
22 Coppice Green Bracknell Berkshire RG42 1TL
01/09/2017 to Present
Previous address
Date lived at address
7 Earlswood Bracknell Bracknell Forest RG12 7LB

31 Meadow Way Bracknell Bracknell Forest RG42 1UE 01/02/2016 to 31/08/2017

01/04/2006 to 31/01/2016

Employment and Income Details

Employment and Income Details

Armed Forces Priority*

No

Are you or the joint applicant (if applicable) working 16 hrs per week or more (paid or voluntary)?*
Yes

If yes, please give us as much information as possible relating to your working situation in the questions below. This will
speed up prioritising your application based on your working situation when you bid for properties.

Employment Details - Main Applicant

Occupation 1
Mechanic

Employer name
Bracknell Mobile Mechanics

Employer address
22 Coppice Green

Date Started
01/01/1999

Amount of monthly take home pay

2000

Occupation 2
not entered
Employer name
not entered

Employer address
not entered

Date Started
not entered

Amount of monthly take home pay

0

Occupation 3
not entered

Employer name
not entered

Employer address
not entered

Date Started
not entered

Amount of monthly take home pay

0

Employment Details - Joint Applicant (if applicable)

Occupation 1
not entered

Employer name
not entered

Employer address
not entered

Date Started
not entered

Amount of monthly take home pay

0

Occupation 2
not entered

Employer name
not entered

Employer address
not entered

Date Started
not entered

Amount of monthly take home pay

0

Occupation 3
not entered

Employer name
not entered

Employer address
not entered

Date Started
not entered

Amount of monthly take home pay

0

Benefits, savings and other income - Main Applicant

If applicable, state what benefit types you recevice, e.g. Universal Credit, tax credits, ESA, etc.
not entered

Total monthly benefits amount

0
Do you have savings? If yes, how much?
not selected

Benefits, savings and other income - Joint Applicant (if applicable)

If applicable, state what benefit types you recevice, e.g. Universal Credit, tax credits, ESA, etc.
not entered

Total monthly benefits amount

0

Do you have savings? If yes, how much?

not selected

Where You Live Now

Where You Live Now
Current property type*
House

Do you need to move on from this accommodation?*

Yes

Is there a date for you to move on? If yes, please specify date
31/01/2019

Details of your accommodation

How many bedrooms are available for you to use?**

1

Do any children have to share a bedroom?*

Yes

If yes, do children aged 10 or more, of opposite sexes, have to share a bedroom?*

No

Or, do any children aged under 10, of opposite sexes, have to share a bedroom?*
No

Are you a Housing Association tenant under occupying family accommodation?*

No

Would you consider moving to a property with fewer bedrooms?*

Yes

For older applicants, would you consider sheltered accommodation?*

No

For older applicants, would you consider a bungalow?*

Yes

Are two or more adults (who are not partners) sharing a bedroom?*
No

Do you have a kitchen?*

Yes

Do you have a bathroom?*

Yes

Is your property adapted for someone with a disability?*

No

If you live in a flat / maisonette which floor is it on?

not selected

Is there a lift?*
No

Rooms shared with people who are not part of your household

Living Room*
Yes

Who do you share with?

Mr Frost and his two children

Bedroom*
No

Who do you share with?

not entered

Kitchen*
Yes

Who do you share with?

Mr Frost and his two children

Bathroom*
Yes

Who do you share with?

Mr Frost and his two children

Toilet*
Yes

Who do you share with?

Mr Frost and his two children

Are there any problems with your tenancy, such as

Anti Social Behaviour

Bailiff's Warrant
Court Order requiring you to leave your home
Harassment
Notice of seeking Possession
Notice to quit
Nuisance
Rent Arrears
Repairs
Violence / Abuse
Other

If other, please specify

not entered

Any other Legal order?*

No

If yes, please specify

not entered

Owner-Occupier
Owner-Occupier
Do you or the joint applicant own, or have ever owned, a property?*
No

If yes, give the address(es) and advise whether or not you still have any interest, financial or otherwise in the property.

Address
not entered

Interest
not entered

Current Owner-Occupier (please give details)

Approximate value of present property?

0

Name and Address of Lending (i.e. Bank, Building Society, etc.)

not entered
Health and Medical Needs
Health and Medical Needs
Do you, or any of your household, have a serious illness, disability or other special need, which makes your present home
unsuitable*
No

If yes, please specify

not entered

If you have answered yes to the above question to assess your requirements the medical professional(s) involved in your
care may need to be contacted

Do we have your permission to contact them?*

No

If yes, give details of their Name, Position, Address and Phone Number
not entered

Do you think you need a specially adapted property?*

No

Do you need to move within the Bracknell Forest Council area to give or receive support?*
No

If yes, please specify

not entered

Area of Preference
Area of Preference

Do you wish to be considered for any part-rent / part-buy (shared ownership schemes that may be available now or in the
future) ?*
No

Connection with Bracknell Forest Council or

partner Housing Associations
Connection with Bracknell Forest Council or partner Housing Associations
Are you or any member of your household related to any employee of Bracknell Forest Council or partner Housing
Association, or any elected member of the above?*
No

If yes, please specify

not entered

Contact with other Agencies

Contact with other Agencies
Do you, or any member of your household, have contact with, or support from any of the following

CAB
Child's School
Community Learning Disability Team
Community Mental Health Team
Doctor
Floating Housing Support
Health Visitor
Probation Services
Social Services
 Voluntary Agencies
Youth Offending Service
Other

If yes, please specify

not entered

Criminal Convictions
Criminal Convictions
Please give details of any criminal convictions or civil proceedings for anti-social behaviour against you and/or any member of
your household within the last 5 years
not entered

Additional Information
Additional Information
Please give details of any other information that is relevant to your application
My landlord has requested that I leave by the end of the month

Declaration
Declaration: Section 171 of the Housing Act 1996 Part IV
It is an offence for any person, knowingly or recklessly to make a false statement or to withhold information requested,
with the intention of misleading a local authority for the purpose of obtaining social housing. This includes unreasonable
failure by the applicant to notify the authority of a change in circumstances while it is considering an application. The
offence is punishable by a fine up to level five (currently £5,000).

l I / we understand that proof of my, my household's, identity must be provided, before any offer of accommodation can be
made.
l I / we understand that the information on this application form is available to other departments within the Council,
including the Anti-Fraud Team.
l I / we understand that the information provided on this application form will be given to social housing providers, such as
housing associations and other local authorities.
l I / we understand that the information on this form may, if appropriate, be shared with other statutory or non-statutory
agencies.
l I / we declare that the details given for the purpose of this application are correct.
l I / we declare that I / we have not withheld any information.
l I / we authorise the Council to make any necessary enquiries to check the information given is correct and this may
include Police checks.
l I / we have read, or have had this document read to me / us, and I / we understand and agree with the details.
l I / we understand what is expected of me / us under Section 171 of the 1996 Housing Act Part IV.
l I / we authorise any agency support worker who is contracted by the council to give information to support my / our
application.
This Authority is under a duty to protect the public funds it administers, and to this end it may use the information you have
provided on this form within the Authority, for the prevention and detection of fraud. It may also share this information with other
bodies administering public funds, solely for these purposes.

Accept Declaration*
Yes

Confirm details are correct

Confirm details are correct
Please check that all the details you have entered are correct

Once you click the submit button below you can change your details but any changes will have to be validated by a member of
staff.