Accommodation Enquiry Form Date Please Attach Or Scan A

accommodation enquiry form date: please attach or scan a recent colour photo here title: dr/mr/mrs/ms surname: first name

Accommodation Enquiry Form
Date:
Please attach or scan a recent colour photo here
Title: Dr/Mr/Mrs/Ms
Surname:
First name:
Email:
Home Address:
Telephone: Home: Mobile:
Work: Bleep:
Employer: (Name of Trust):
Name of Hospital & Dept:
Job Title:
Will the applicant be:
Full time
salaried employee
in a permanent position
Y es No
Yes No
Yes No
If NO, please provide additional information:
Date of joining WSHFT:
For Confirmation of Employment/Placement: (name of WSHT Line Manager):
Type of Property Required: All accommodation subject to availability
Single Room (Worthing)
Single Room (St Richards)
F1 Doctors’ House (St Richards)
(St Richards only):
2 Bed Flat (max. 3 people) No. of adults No. of children:
Accommodation required - from: to
(please provide exact dates, applications without these will not be
processed)
Do you have any preferences / requirements you would like us to
consider upon allocation of accommodation? (Although every effort will
be made to meet special requests, these are not guaranteed)
For Official Use Only: (To be completed by Accommodation Staff)
Allocated Address: Aberdare/Horton/ParkRd
Date of Entry: from to
Type of Tenancy: dated / six months / 1 year
Collection Method: salary deduction / Individual Invoice
Priority Number 1 2 3 4 5 6
Further Information and comments:
/var/www/doc4pdf.com/temp/879328.doc2