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Tel: 086 412 6381 - 083 3572882
info@thehomeshare.ie
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Share My Home – Online Application Form
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Share My Home – Online Application Form
Please fill out the application form below and our team will contact you within 24 hours
Proposer Details
(Please fill in as much detail as possible as this will improve your chance of being matched)
Name*
Householder Name*
Email*
Phone*
Date Of Birth (Must be at least 18)*
Are you male or female?*
Male
Female
Current address*
Additional Information
How did you hear about us?*
Google
Radio
TV
Referral
Newspaper
Other
Why do you want to share your home?
Have you discussed this with members of your family?*
Yes
No
Do you live alone?*
Yes
No
Do you have a spare room ready for a homesharer?*
Yes
No
Do you have any medical conditions that may be relevant or your homesharer would need to be aware of?*
Yes
No
Would you like 10 hours of support each week?*
Yes
No
If you answered YES to above, what support would you require?
Have you any pets?*
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?*
Yes
No
Are you willing to provide a medical certificate from your GP and 2 references?*
Yes
No
