City Care Housing

Do you smoke? *

Yes

No

Do you drink alcohol? *

Yes

No

Do you take drugs?*

Yes

No

Do you have a criminal record? *

Yes

No

Are you employed?**

Yes

No

Do You Have a Next of Kin Details?*

Yes

No

Do You Have a Current Landlord?*

Yes

No

Do You Have a Probation Officer?*

Yes

No

Do You Have a CPN Worker?*

Yes

No

Do you have a Social/Key Worker?*

Yes

No

Is a professional filling this form in on behalf of the applicant?*

Yes

No

REFERRALS