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Share My Home – Online Application Form
thehomeshare
2017-07-14T00:23:15+00:00
Share My Home – Online Application Form
Please fill out our application form below and our team will be back to you as soon as possible.
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1
Proposer Details
Name
Householder Name
Address
0
/
Phone
Email
Date Of Birth
Additional Information
How did you hear about us?
Select An Option
Google
Radio
TV
Referral
Newspaper
Other
Why do you want to share your home?
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/
Have you discussed this with members of your family?
Select An Option
Yes
No
Do you live alone?
Select An Option
Yes
No
Do you have a spare room ready for a homesharer?
Select An Option
Yes
No
Do you have any medical conditions that may be relevant or your homesharer would need to be aware of?
Select An Option
Yes
No
Would you like 10 hours of support each week?
Select An Option
Yes
No
If you answered YES to above, what support would you require?
0
/
Have you any pets?
Select An Option
Yes
No
Have you any preference on male or female homesharer?
Select An Option
Male
Female
I Don't Mind
Have you a preference for a professional or student?
Select An Option
Professional
Student
I Don't Mind
Have you any preference on nationality of the homesharer?
Select An Option
Yes
No
Are you willing to provide a medical certificate from your GP and 2 references?
Select An Option
Yes
No
Submit Application
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