CHECK YOUR ELIGIBILITY

Are you under 25 years old? *

YesNo

Are you currently earning an income? *

YesNo

Are you employed? *

YesNo

You are eligible for the JumpStart program!

Please click the "Next" button to continue to the Application Form:

Unfortunately, you are not eligible for the JumpStart program.

For housing assistance, please contact Housing Connect on 1800 800 588.

JUMPSTART APPLICATION FORM

PERSONAL DETAILS

First Name *

(Preferred Name)

Last Name *

Date of Birth *

Gender *

Other *

Pronouns *

Other *

ATSI Status *

Occupation *

Phone *

Email Address

EMPLOYMENT DETAILS

Employer #1

Are you an Apprentice / Trainee? *

YesNo

Employer name *

Phone *

Address *

Employment commencement date *

Apprenticeship / Traineeship commencement date *

Length of Apprenticeship / Traineeship (in years) *

Employment type *

Hours per week *

Do you have another employer? *

YesNo

Employer #2

Employer name *

Phone *

Address *

Employment commencement date *

Employment type *

Hours per week *

$ INCOME DETAILS

Employment income per fortnight $ *

Centrelink benefit income per fortnight $ *

Other additional income per fortnight $ *

Centrelink Reference Number *

Type of Payment *

EMERGENCY CONTACT DETAILS

Name *

Relationship to you *

Phone *

Email Address

PROPERTY DETAILS

Are you: *

Currently renting in a private rentalCurrently renting in a share house rentalLooking for a private rentalLooking for share house rental

What is your location preference *

Region *

Current Address

Required length of tenancy *

Preferred commencement date *

Preferred rent /week $ *

Address *

Region *

How long have you been renting there (Start date) *

Length of Lease (in years) *

Rent /week $ *

Landlord/Agency name *

Landlord/Agency phone *

Landlord/Agency email

OCCUPANCY DETAILS

Do you have pets? *

Yes - InsideYes - OutsideNo

How many? *

What type? *

Breed *

Number of vehicles *

Registration numbers *

Do you smoke? *

YesNo

NOTE: IT IS OUR POLICY THAT THERE IS TO BE NO SMOKING INSIDE ANY HOME BASE RENTAL PROPERTIES.

Do you have any current debts associated with a private owner or Real Estate *

YesNo

Please provide details *

Rental History (where applicable)

Do you have any rental history? *

YesNo

Landlord/Agents name *

Phone *

Property Address *

Rent /week *

Period of lease *

Bond refunded *

YesNo

Where did you find out about JumpStart and/or Home Base? *

Other *

Please provide us with any further details / comments

Please also email the following files to jumpstart@homebasetas.org.au

1. Proof of identification (e.g. Driver's License, Photo ID, Birth Certificate, Passport, Bank Statement)

2. Confirmation of work including proof of income (e.g. Two most recent payslips)

3a. Lease details if in current private rental (Subsidy Stream only)

3b. Personal Information Report - Tasmanian Collection Service (Share House only) (Applicable to applicants 18+ only)

PRIVACY ACT (COMMONWEALTH) 1988 - COLLECTION NOTICE

The personal information the prospective tenant provides in this application or that which is collected from other sources is necessary for the Agent to verify the Applicant's identity to process and evaluate the application and effectively manage the tenancy. The personal information collected about the Applicant may be disclosed, by use of the internet or otherwise, to other parties, including the landlord, trades people, referees, solicitors, financial institutions, media organizations, parties engaged to evaluate the property, bodies corporate, other agents, clients of the Agent both existing and potential, third party operators of tenancy reference databases, government, collection agencies, relevant Courts and Tribunals, and statutory bodies and other third parties as required by law.

Information already held on tenancy reference databases may also be disclosed to the Agent and/or landlord. Unless you advise the Agent to the contrary, the Agent may also disclose such basic information to The Real Estate Institute of Tasmania Ltd (REIT) for the purpose of documenting leasing data in the area for the benefit of its members as part of membership services and for others in the property or related industries, and so as to assist them in continuing to provide the best possible service to their clients.

In providing this information, you agree to its use, unless you advise the Agent differently. The privacy policy of the REIT can be viewed on its website www.reit.com.au.

The Agent will only disclose information in this way to other parties to achieve the purposes specified above or as otherwise allowed under the Privacy Act. If the Applicant would like to access this information they can do so by contacting the Agent at the address and contact numbers contained in this Application or the REIT on (03) 62234769. The Applicant can also correct this information if it is inaccurate, incomplete or out of date.

I acknowledge that I/We have read and understood the contents of the Privacy Collection Notice.

Applicant Signature *

Clear