About BHC Mission & Vision BHC Team Board Members H.U.S.T.L.E. Truck HomeStart Senior & Disabled Loans Tenders & RFP’s Current Tenders & RFP’s Planned Developments Forms & Links Contact BHC BHC Application Form Step 1 of 3 - Demographics 0% Standard Questions for all applicants. Use the word NONE if the question does not apply. Driver’s Licence, passport and other documents (notices to quit, eviction notices, pay stubs and other substantiating documents) need to be uploaded. Tenant can upload pictures taken from their mobile devices. DemographicsName* First Middle Initials Last Previous Names (Maiden, Last known as) Date of Birth* Date Format: MM slash DD slash YYYY Bermudian*YesNoCurrent Home AddressEmail AddressContact Number (Mobile)Contact Number (Work)Total Number of Adults (including the applicant) who will reside in the householdPlease enter a number from 0 to 20.Total Number of Children who will reside in the householdPlease enter a number from 0 to 20.Applicant 1 Name, Age, Gender, Relationship, EmploymentFor each household member enter their name, age, gender, how they are related, whether they are employed or in school.Applicant 2 Name, Age, Gender, Relationship, EmploymentFor each household member enter their name, age, gender, how they are related, whether they are employed or in school.Applicant 3 Name, Age, Gender, Relationship, EmploymentFor each household member enter their name, age, gender, how they are related, whether they are employed or in school.Applicant 4 Name, Age, Gender, Relationship, EmploymentFor each household member enter their name, age, gender, how they are related, whether they are employed or in school.Applicant 5 Name, Age, Gender, Relationship, EmploymentFor each household member enter their name, age, gender, how they are related, whether they are employed or in school.Applicant 6 Name, Age, Gender, Relationship, EmploymentFor each household member enter their name, age, gender, how they are related, whether they are employed or in school.Are you currently renting?YesNoHow much is your current rent?Have you ever rented from BHC?YesNoIf yes, what was your reason for leaving?AffordabilityArrearsEvictionLocationFamily issuesIf you have arrears or bad debt with BHC, have you attempted to pay on it?YesNoI don't have arrears or bad debt with BHCDriver's Licence or Passport* Drop files here or Accepted file types: jpg, gif, png, pdf. Tenant can upload pictures taken from their mobile devices.Other Documents Drop files here or E.g. notices to quit, eviction notices, pay stubs and other substantiating documents. EmploymentAre you employed?*YesNoType of employment Part time Full time Temporary Permanent Have you applied to the Department of Workforce DevelopmentYesNoCurrent employerEmployer's address and contact info (email, phone number)Describe or explain your current employment information, i.e. length of time, conditions, security of employment, etc.FinancingHow will you pay rent? Income/Salary Financial Assistance Pension Disability Do you have funds set aside for a security deposit?YesNoIf you require Financial Assistance have you already applied?YesNoHow much does Financial Assistance pay towards your rent?What is your household's WEEKLY salary?This is the total for everyone over 18 years of age.What is your household's MONTHLY salary?This is the total for everyone over 18 years of age.Do you or any household member own a home or have any property assets?YesNoWhat type of transportation do you own? HousingType of Housing RequiredRoom rentalStudio Apartment1-bedroom2-bedroom3-bedroomReasons for housing A: Homeless B: Housing needed within a week C: Domestic issues D: Referral by agency E: Possession granted - court order F: Disaster G: Household with small children H: Written or verbal notice I: Health & safety J: Space too small K: Disability L: Current tenant M: Cost - cannot afford rent N: Space too large O: Quality - looking for better neighborhood P: Quality - current abode needs repair Q: Other R: Evicted from family home / a family member's home Check all that applyOther reason for housingHow long have you lived in your current housing?Describe in your own words the overall reason you require housingWhat Date are you required to leave your current housing? Date Format: MM slash DD slash YYYY Do you have a Notice to Vacate?YesNoHave you been to court?YesNoWhat is the name and contact information for your landlord?Is the communication with your landlord in good standing?YesNoDo you have arrears?YesNoIf yes, how much?Have you ever been evicted?YesNoIf yes, why?Does any household member have any special housing needs? i.e. mobility requirements?Are there other agencies involved with your family? A: DCFS, Adolescent, Family Services B: Department of FA C: MAWI D: KEMH E: Court Services F: Department of Corrections G: Centre Against Abuse H: Other What other resources have you used to find housing? Real estate agencies Local media sources Emoo Newspapers Word of mouth Do you have a parish or location preferences?Do you have a bank account?YesNoDo you have debt with collection agencies?YesNoHow much is your total debt?Are you able to have utilities, such as BELCO connected in your name?YesNoDo you have appliances and furniture?YesNoHow would you describe your housekeeping practices?PoorGoodExcellentHas a landlord ever complained about your housekeeping practices?YesNoHas you ever been evicted because of this complaint?YesNoProvide any other information or questions that can help with your application process.PhoneThis field is for validation purposes and should be left unchanged.
