Housing Rental Application Form Application Information Name * Date of Birth (Month, Date, Year) * Social Insurance Number * Phone * Permanent Address * City * Province * Postal Code * Marital Status * Single Married Common Law Other Employment Information School * Choose one... Anzac Community School - Bill Woodward School Athabasca Delta Community School Bishop Routhier School Calling Lake School Career Pathways School Chipewyan Lake School Conklin Community School Elizabeth School Father R. Perin School Fort McKay School Gift Lake School Grouard Northland School Hillview School J.F Dion School Mistassiniy School Paddle Prairie School Pelican Mountain School St. Theresa School Susa Creek School Emergency Contact Name of a person not residing with you * Address * City * Province * Postal Code * Phone * Name, Ages and Relationship of Intended Occupants Occupant 1 Name Age Relationship Occupant 2 Name Age Relationship Occupant 3 Name Age Relationship Occupant 4 Name Age Relationship Occupant 5 Name Age Relationship Pets and Smoking Pets: As per the lease agreement, tenants are a maximum of three pets per household. Smoking: As per Administrative Procedure 162, All of the facilities, grounds and fleet vehicles under the control of the Division are to be smoke-free areas. This includes the housing units owned by the Division in various communities. Pets * Yes No If you said yes please specify Smoking * Yes No References - No Relatives or Employers Reference 1 Name Address * Postal Code * Reference 2 Name Address Phone Personal Email Address Email * Move In Date Expected Move In Date * Leave Blank
