Housing
Application Form
For oce use only:
Applicaon reference number:
Main applicant name:
Date received:
HOUSING APPLICATION FORM 3
Contents
What is the Common Housing Register 4
Data Protection Act 2018 4 – 7
Application form - Section 1 8 – 10
Section 2 - Details about your household 11 – 12
Section 3 - Current accommodation 13 – 16
Section 4 - Housing preferences / needs 17 – 18
Section 5 - Landlord and letting areas 19 – 25
6 - Harassment or disturbance 25 – 26
Section 7 - Relationships to sta 27
Declaration 28
Condential Survey 29
CHR partner landlord contact details 30
4 HOUSING APPLICATION FORM
What is the Common Housing Register (CHR)?
The North Lanarkshire Common Housing Register is a partnership between North Lanarkshire Council and
partner Registered Social Landlords (Housing Associations and Co-operatives) who have social rented
housing stock in the North Lanarkshire area.
The CHR lets you apply for social rented housing owned by any of the partner landlords by using just one
application form. Information from your application form will go on a register, which each of the partner
landlords can access. If they consider you for housing, they will award you a priority according to their own
allocation policy. Oers of housing will depend on the level of priority you have and your needs and
preferences about the area and the type of housing available to let.
You can get housing advice from any of the CHR landlords. This advice can include information on
choosing an area, types of housing available, size of housing required and so on.
Who can apply?
You can apply for housing in North Lanarkshire using this form if you are aged 16 or over. This
includes people applying from inside and outside the North Lanarkshire area as well as current
tenants who want to transfer to other accommodaon or register for a mutual exchange (house
swap). However, if you have come to Britain from abroad it is possible that the Council will not be
able to consider you for housing.
If you are homeless or think you may become homeless in the near
future
Contact any of the council oces on the back page of this document. They will assess your housing
situaon and give you advice about your housing opons.
The Common Housing Register partner landlords
Cairn Housing Associaon Clyde Valley Housing Associaon
Forgewood Housing Co-operave Garrion People’s Housing Co-operave
Lanarkshire Housing Associaon North Lanarkshire Council
Sanctuary Scotland Housing Associaon West of Scotland Housing Associaon
Wishaw and District Housing
The contact details for all partner landlords including all of the North Lanarkshire Council oces can
be found on the back page of this form.
The leng areas in North Lanarkshire where each of the partner landlord have social rented housing
stock is located on pages 20-24 of this form.
Data Protection Act 2018 - Protecting your Information
We will keep all the informaon you give us in this form and any other documents connected with
this, on the CHR computer system. All of your chosen partner landlords will be able to use this
informaon to assess your housing needs. We will use this informaon in line with the General Data
Protecons Regulaons 2016/679 (“GDPR”) and the Data Protecon Act 2018.
We may contact other third pares to get further relevant informaon to help us process your
applicaon. This may include your current or previous landlords; medical and health professionals;
the police; other services or agencies with relevant informaon.
HOUSING APPLICATION FORM 5
The informaon you provide will be used to assess your applicaon in accordance with the
Allocaon Policy of the partner landlords and match your requirements and preferences against any
available properes.
The informaon will also be used for stascal and monitoring purposes.
We will not disclose your personal data beyond the partner landlords or third pares described
above in connecon with the purposes of your applicaon except where required to do so by law or
unless you have given your permission to do so.
North Lanarkshire Common Housing Register Privacy Statement
The North Lanarkshire Common Housing Register is a partnership made up of the following social
housing landlords: Cairn Housing Associaon; Clyde Valley Housing Associaon; Forgewood Housing
Co-operave; Garrion Peoples Housing Co-operave; Lanarkshire Housing Associaon; North
Lanarkshire Council; Sanctuary Scotland Housing Associaon; West of Scotland Housing Associaon
and Wishaw and District Housing.
Each partner landlord is known as a “data controller” and is registered with the Informaon
Commissioner. Each partner landlord processes personal informaon in line with the General Data
Protecon Regulaon (GDPR) which came into force on 25th May 2018.
Privacy
We are commied to protecng your privacy in line with the requirements of the GDPR. Any personal
informaon provided to us will only be used to discharge our statutory funcons under the Housing
(Scotland) Act 1987 & Housing (Scotland) Act 2001 and other relevant legislaon.
This document explains why we collect personal informaon, how we use it, who we may share it
with and how we keep it secure.
How we collect information about you
We collect informaon about you and your household when you submit an applicaon form to the
North Lanarkshire Common Housing Register. Addionally we will collect informaon when you
contact us directly, when we meet with you to discuss your housing opons, when you submit a
change of circumstances form and at an annual review of your applicaon if applicable.
We may also collect informaon from any agency which you make reference to in support of your
applicaon. This may include, but is not limited to the following:
• Your current landlord and /or your previous landlords up to a period of 5 years.
• Health and Support agencies which you have stated that you use e.g. North Lanarkshire Council’s
Health and Social Care service, other Local Authority Social Work departments, Local Authority
Homeless Services.
• Other agencies such as Armed Forces, Home Oce, Police, Scosh Prison Service, NHS Scotland
and GPs and other health professionals.
6 HOUSING APPLICATION FORM
Why we need the information you are asked to provide on the
application form
We need the informaon on the applicaon for the following purposes:
• To process and manage applicaons for social housing in the North Lanarkshire area.
• To decide if you are eligible for housing.
• To accurately assess your housing needs and allow the partner landlords to give you help and
advice with your housing opons.
• To reply to enquiries and contact you when required.
• To make oers of housing to suit your needs and aspiraons.
• To sign up new tenants when oers of housing are accepted.
• To provide stascal informaon to inform the Local Housing Strategy and any other relevant
strategies which inform planning for future housing needs.
• To provide stascal informaon to relevant benchmarking clubs.
• To meet our legal obligaons in providing informaon, including stascal informaon, to the
Scosh Housing Regulator (SHR) and the Scosh Government (SG).
How your information is stored and how long it is kept
The informaon you provide on your applicaon form is transferred to an electronic soware system
managed by North Lanarkshire Council.
All computers are kept in a secure locaon and are password protected. Access to our electronic les
kept on the shared network is controlled by user log in and passwords, making access to data only
available to those who need to use it.
Our computer systems are located in each member’s oces, but occasionally we may use computers
osite. However, they will at all mes remain secure and under our control.
The hard copy of your applicaon will be kept by the partner member who receives and processes
your applicaon. This will be kept unl you are either re-housed, in which case your applicaon will
be sent to the partner member with whom you have been rehoused, or cancelled, in which case
your applicaon will be kept for a period of 1 year and then destroyed.
Who can access your information?
Only relevant sta of the parcipang partner landlords that you have chosen to be housed with
have access to your informaon.
Addionally a small number of sta from North Lanarkshire Council will be able to see informaon
provided by you in order to:
• Produce reports required for the partners you have chosen for administrave purposes.
• Gather stascal informaon for planning for future housing needs.
• Undertake quality assurance audits, including ensuring that the informaon you have provided
has been properly recorded.
• Use the personal informaon on this form to ensure that everyone is treated equally, whatever
their ethnic background.
• Contact you as part of a statutory consultaon process e.g. when a partner landlord is reviewing
their allocaon policy.
• Operate the Common Housing Register system on behalf of a partner landlord where they have
asked us to do so.
HOUSING APPLICATION FORM 7
Who we may share it with
All personal data we process is only processed by our sta based in the UK.
Your informaon may be passed to:
• Health and Support agencies which you have stated that you use e.g. North Lanarkshire Council’s
Health and Social Care, other Local Authority Social Work departments, Local Authority Homeless
Services.
• Other agencies such as Armed Forces, Home Oce, Police, Scosh Prison Service, NHS Scotland
and GPs and other health professionals.
Data may also be matched with data held on other computer systems for the prevenon and
detecon of fraud and to assist applicants who may benet from services provided by North
Lanarkshire Council’s Enterprise and Communies or Health and Social Care.
Your rights
You have the right at any me to:
• Ask for a copy of the informaon about you held by us in our records.
• Require us to correct any inaccuracies in your informaon.
• Make a request to delete what personal data of yours that we hold.
• Ask us to restrict how we use your personal data.
If you would like to exercise any of your rights above please contact:
Business Development and Support Manager
Business Development and Support
Enterprise and Communies
3rd Floor Civic Centre
Windmillhill Street
Motherwell ML1 1AB
Telephone: 01698 274139
You also have the right to complain to the Informaon Commissioner’s Oce in relaon to our use
of your informaon. The Informaon Commissioner’s contact details are noted below:
The Informaon Commissioner’s Oce
Wyclie House
Water Lane
Wilmslow
Cheshire SK9 5AF
Telephone: 0303 123 1113 (local rate) or 01625 545745
Website: hps://ico.org.uk/concerns
8 HOUSING APPLICATION FORM
Section 1 Are you eligible for housing?
If you have come to live in the UK from abroad, under the Housing (Scotland) Act 2001 and the
Asylum and Immigraon Act 1999 local authories must nd out if you qualify for public help,
including housing.
Application form
Informaon in this applicaon form allows your chosen landlords to assess your housing needs
accurately, so it is very important that you ll in all of the secons.
1c Do you or anyone who will be housed by you currently own
or have previously owned another property or land?
1a Are you and all members of your household British citizens?
Home Ownership
The Housing (Scotland) Act 2014 removes the restricon on taking home ownership into account.
Some landlords may take property ownership into account when assessing an applicaon for
housing. A property can be owned by the applicant or another member of their household who is
currently living with them or someone who is intending to live with them. This is not restricted to
property in Scotland or even the UK, but could be any property which is owned (or previously
owned) by the applicant or a member of their household or proposed household and includes
ownership of land (and anything built on that land) as well as the actual property itself. There are
some circumstances where a landlord cannot take account of property ownership.
We may speak to the immigraon authories or associated organisaons to check the
informaon that you have given us and to get more relevant informaon.
If you are not sure whether this applies to you, please contact North Lanarkshire Council or any of
the partner landlords on the back page of this form.
1b If you have answered ‘No’, please tell us your and/or their nationality.
Yes
Yes
No
No
If yes, is the current status of this sold or rented
Please give the address or locaons of the property or land
HOUSING APPLICATION FORM 9
Main applicant: Please tell us all the addresses you have lived at for the last ve years.
Address and postcode Start date End date Reason for leaving Who was the landlord/who
owned the property (please
give name, address and
postcode)
If you are currently under the age of 26 please tell us if you have ever been
previously looked aer and accommodated by North Lanarkshire Council.
(This means if you have ever been in foster care or in a kinship arrangement,
or accommodated in a children’s home.)
Yes No
Preferred method of communicaon
What date did you start living at this address?
Current address and post code
Mobile number
Dayme telephone number
e-mail address
Naonal Insurance Number
Date of birth
Previously known as
First name(s)
Last name
Title
Are you, or have you ever been known by any other name?
(an example of this could be your maiden name, or if you have changed your name)
Please tell us who owns this property and provide their full contact details including post code and
telephone number (this could be a council, a private landlord or a housing association or the property could be owned
by a relative such as your mum or dad).
1d Information about you
(a joint applicant will become a joint tenant with the main applicant if a future tenancy is taken up as a result of this applicaon)
What address would you like us to send any leers to (if dierent from the main applicant’s current address)?
10 HOUSING APPLICATION FORM
If you are currently under the age of 26 please tell us if you have ever been
previously looked aer and accommodated by North Lanarkshire Council.
(This means if you have ever been in foster care or in a kinship arrangement, or accommodated
in a children home.)
Please tell us who owns this property and provide their full contact details including post code and
telephone number (this could be a council, a private landlord or a housing association or the property could be owned
by a relative such as your mum or dad).
1e Information about any joint applicant
(a joint applicant will become a joint tenant with the main applicant if a future tenancy is taken up as a result of this applicaon)
Joint applicant: Please tell us all the addresses you have lived at for the last ve years.
Yes No
Address and postcode Start date End date Reason for leaving Who was the landlord/who
owned the property (please
give name, address and
postcode)
Preferred method of communicaon
What date did you start living at this address?
Current address and post code
Mobile number
Dayme telephone number
e-mail address
Naonal Insurance Number
Date of birth
Previously known as
First name(s)
Last name
Title
Are you, or have you ever been known by any other name?
(an example of this could be your maiden name, or if you have changed your name)
HOUSING APPLICATION FORM 11
2c Are any household members at your current address or
who will move with you, part of a couple?
Please tell us who these household members are:
Section 2 Details about your household
2a Starting with yourself please give details of everyone living at your
current address.
2b Please give details of everyone who is not living with you,
but who want to be housed with you
Yes No
Name
Name
Date of
birth
Date of
birth
Naonal Insurance
number
Naonal Insurance
number
Sex
(male or
female)
Sex (male or
female)
Relaonship
to the main
applicant
Relaonship to
the main applicant
This perosns current
address
Will this person move
with you?
Reason why this person
is not living with you
now
12 HOUSING APPLICATION FORM
2f Are you or anyone who will be housed with you pregnant?
2e Does anyone regularly stay with you overnight for whom
you have parental responsibility?
For example a child from a previous relaonship,
or do you have a carer who regularly stay overnight in your home?
2d As well as the joint applicant you have told us about in
question 1b, are there any more joint applicants you want to
add to your application.
Yes
Yes
Yes
No
No
No
Name of person who is pregnant
Please give us details of the current access arrangement for your child/children, and/or details about
your care arrangements:
Date child is due
Please provide proof of pregnancy, such as a leer from their hospital or GP
Name Date of
birth
Naonal Insurance
number
Sex
(male or
female)
Relaonship
to you
Current address If this person is
a child do you
have access
arrangements
YES NO
If this
person
is your
carer
please
ck
How oen
will this
person stay
with you
overnight
HOUSING APPLICATION FORM 13
Detached bungalow
In residential care
Detached bungalow
Staying in supported accommodation
An owner occupier
End terrace
In prison
End terrace
Staying in homeless accommodation
A tenant of a Housing Association or
co-operative within North Lanarkshire
A tenant of a house that you live in because of
your job
Detached
Tenant of a private landlord
Detached
Lodger
A tenant of North Lanarkshire Council
Semi detached bungalow
In HM Forces accommodation
Semi detached bungalow
Staying in bed and breakfast
Staying with parents
Mid terrace
In hospital
Mid terrace
Staying in a hostel
A tenant of a Housing Association or
co-operative outside North Lanarkshire
A shared owner of a house with a
housing association or co-operative
Semi detached
Semi detached
Staying in a caravan or mobile home
A tenant of another council
End terrace bungalow
End terrace bungalow
Living rough (rooess, in car etc)
Staying with other relatives or friends
Mid terrace bungalow
Mid terrace bungalow
Being looked after and accommodated by a
local authority (including foster care, kinship
arrangements, residential home etc)
Living with partner who you want to leave
Mul storey tower
If none of the above apply, please give details here:
If none of the above apply, please give details here:
Upper four in a block at
3b What kind of property do you currently live in? (please ck)
Section 3 Current Accommodation
This secon allows us to collect informaon on your current housing situaon and to help us to nd
out what type of tenancy you have with your current landlord. It also helps us assess whether your
current housing situaon is secure so that we may oer you advice or assistance should you be
homeless now or in the future.
3a Please tick whichever box best describes your current accommodation
and tenure type
14 HOUSING APPLICATION FORM
Does the property have dangerous wiring and electrical xtures?
Yes No
Does the property need major repairs?
Has a closing order been served on the property?
(this means a local authority has said that nobody can live in the house)
3e Do you and your partner have a bedroom to yourself?
(for example, you do not share the bedroom with anyone other than your partner).
3d We need to know how many room there are in your current home,
please tell us below.
3c If you stay in an upper flat or maisonette,
please tell us what floor level you live on.
Structural problems
Dampness or water leaks
Is your home a bedsit or studio?
3f Does anyone in your household sleep in the living room?
Is there a window in
each bedroom?
Cooking facilies Mains electricity
Sink Kitchen or kitchen area
Inside toilet Bath or shower room
Cold water supply Hot water supply
Problem:
Number of rooms Tick if you share with another household
3i Does your home have any of the following problems?
Please ck all that apply and provide the appropriate evidence. Please note
that further assessment may be required.
3h Do you have acces s to the following facilities in your home?
3g How many bedrooms in your home are not used for sleeping in?
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
No
No
No
No
No
No
No
No
No No
No No
No No
No No
Has the property been declared below the ‘tolerable standard’?
(Below the tolerable standard means that the property has been inspected by a
local authority Environmental Services and does not meet the standards in the
Housing (Scotland) Act 1987 and as amended by Housing (Scotland) Act 2006)
Yes No
Living room
Double bedrooms
Single bedrooms
Kitchen
Toilet or bathroom
HOUSING APPLICATION FORM 15
Name of the person receiving the support - address of this person and details of the type of support
that will be provided:
Name of household member who will be providing the support:
3k If you or a member of your household need to move to give support to
someone, please give us details below.
3j Please tell us in your own words why you want to be rehoused.
Please give us as much detail as possible as this will help us to assess your housing needs and award
all the points you may be entled to:
If you have cked yes to any of the above please give more details here:
16 HOUSING APPLICATION FORM
If you have answered yes please explain why?
If yes please provide a copy of the order.
If yes please provide a copy of the noce.
If yes what date have you been told to leave by?
3u Do you have to sell your home?
3s Do you owe any rent to your landlord?
3r If you are a tenant, do you have a written tenancy agreement?
3q Has a court order for possession been granted?
3p Have you been given written notice to leave?
3o Have you been asked to leave your accommodation?
3n Are you or a member of your family experiencing domestic abuse?
3m Are you likely to become homeless in the future?
3l Are you currently homeless?
3t If you own your own home, do you have any arrears
(missed payments) on your mortgage?
Section 4 What type of housing would you prefer or need
The following informaon lets us know the type of housing you would like to be considered for.
If you need specialist housing, you will need to be assessed for your health and housing support needs.
There are examples of specialist housing in queson 4d.
4a Which type of housing would you prefer to live in?
(Please be aware that some house types may not be available in the areas you want to live in. You can get more
informaon on types of housing in each leng area from any of our partner landlords).
Please ck all that apply. The more types of housing you consider, the more chance there is that we
will be able to help you.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
Detached bungalow
End terrace
Detached
Semi detached bungalow
Mid terrace
Semi detached
End terrace bungalow Mid terrace bungalow
Mul storey tower Upper four in a block at
HOUSING APPLICATION FORM 17
Sheltered plus housing – housing designated for older people, generally aged 60 and over, that provides
enhanced housing support services and an emergency response service. It provides one level accessible
accommodaon and access to common facilies in which a range of social opportunies take place. It is
suitable for older people who require some support to live independently.
Rerement housing – housing designated for older people that provides an enhanced housing
management service and an emergency response service. It generally consists of terraced bungalows and
some four in a block common entrance properes, and has access to common facilies where a range of
social opportunies can take place.
Amenity housing – housing designated for older people. It consists of aed or terraced type
accommodaon. There is no on site housing support or enhanced housing management services
provided.
Older peoples housing includes:
Without li
Older peoples housing (provided by North Lanarkshire Council)
With li
Please note that the council’s revised allocaon policy for older peoples housing will mean that
applicants will be matched to the appropriate older peoples’ housing opon(s) which will best meet
their needs.
Please ck the types of specialist housing you want to be considered for.
4d Do you want to be considered for any specialist type housing, such as housing
for older people or housing adapted or designed for people with disabilities or
support needs?
4c If you have said no, what is the highest level you would accept?
(Some RSLs landlords provide Sheltered or Very Sheltered accommodaon, in addion the council
can nominate people from their waing list to some of these landlords)
Sheltered Housing
Yes No
Very Sheltered
Yes No
Amenity housing
(Housing suitable for older people or people with disabilies or support needs)
Yes No
Wheelchair standard housing
Yes
Yes
Yes
No
No
No
Other specialist type of housing:
4b Would you consider any floor level?
Yes No
Lower four in a block at Tenement ground oor at
Tenement upper oor at Upper at in a block of ats
Ground oor at in a block of ats Upper maisonee
Ground oor maisonee
18 HOUSING APPLICATION FORM
Please note that tenants of mul-storey tower block or other ats which have shared access may not
keep any pets without the landlord’s wrien permission. North Lanarkshire Council will not give
permission for dogs or cats to be kept as pets in mul-storey towers.
If you have answered ‘Yes’ please give details
4i Would you prefer to have a garden?
4h Do you have pets?
Yes No Don’t mind
Yes No
Please say which and tell us why.
If you need a larger property please tell us why.
4g Is there any type of heating you do not want to be considered for?
4f What size of house do you need?
You will normally receive a house where the size meets the needs of your family, and will be
based on the allocaon policy house size eligibility rules of the partner landlord making the
oer of housing.
4e If you have answered yes to any of the above,
please give us more details
Yes No
Six Bedrooms Seven Bedrooms
More than this
Three bedroom
Four bedroom
Five bedrooms
Studio / bedsit One bedroom Two bedroom
HOUSING APPLICATION FORM 19
5b Other Social Housing providers within North Lanarkshire
As well as the main partner landlords who operate the Common Housing Register (as above in
queson 5a), there are a number of other housing associaons who have housing stock in the
North Lanarkshire area. North Lanarkshire Council has arrangements in place which enable them to
nominate an applicant from their waing list to some of the vacancies these landlords may have.
If you would like to be considered for this please let us know below.
N.B. Please note that you will only be matched for accommodaon that your chosen landlords have
in your areas of choice see pages 20-24.
Area or streets
Reason why I do not want to be considered
You can only be housed if your chosen landlords have properes in the area you want to live in,
and your needs meet the rules of their allocaon policy. You can check that your chosen landlord
has properes in those areas by looking at the following tables. You can choose as many leng
areas as you want, but you must put a number ‘1’ at your rst choice and then ck the others you
want to be considered for.
5c Are there any areas or streets in the letting areas you have chosen that you
do not want to be considered for?
Section 5 Landlords and Letting Areas
5a Please tick which of the Common Housing Register Partner Landlords you
WANT to be considered by? You may tick as many as you wish.
Abronhill Housing Association
Cairn Housing Association
Bield Housing Association
Clyde Valley Housing Association
Caledonia Housing Association
Forgewood Housing Co-operative
Cube Housing Association
Garrion People’s Housing Co-operative
Hanover (Scotland) Housing Association
Lanarkshire Housing Association
Horizon Housing Association
North Lanarkshire Council
Key Housing
Sanctuary Scotland Housing Association
Bield Housing Association
West of Scotland Housing Association
Loretto Housing Association
Wishaw and District Housing
Link Housing Association
Trust Housing Association
20 HOUSING APPLICATION FORM
5d Please put a number ‘1’ against your first-choice area, then mark all other
areas you want to be considered for with an X.
Abronhill Cumbernauld
Village
Greenfaulds
Kildrum
Seafar /
Ravenswood
Wesield
Balloch / Easield
Carbrain East
Carbrain West
Carbrain South
Castlecary
Condorrat
Bore Road
Gartness
Glenmavis
Greengairs
Holehills
New Petersburn
Northburn /
Airdriehill
Petersburn
Plains
Rochsoles
Salsburgh
Thrashbush
Whinhall etc
Burnfoot
Cairnhill
Calderbank
Caldercruix
Chapelhall
Chapelside etc
Clarkston etc
Coatdyke
Craigneuk - Airdrie
Flowerhill
Gartlea
Cumbernauld
Airdrie
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
Clyde Valley
Housing Associaon
Lanarkshire Housing
Associaon Ltd
North Lanarkshire
Council
West of Scotland
Housing Associaon
Santcuary Scotland
Housing Associaon
Cairn Housing
Associaon
Garrion Housing
Co-operave
Forgewood Housing
Co-operave Ltd
If you need further help with this please contact any of the partner landlords.
Wishaw and District
Housing
HOUSING APPLICATION FORM 21
Bellshill
Viewpark
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
Carn Street Area
New Stevenston
Electric Scheme
Noble Road Area
Old Calder Road
area
Old North Road
Orbiston Drive Area
O’Wood
Quarry Street
Bellshill
Stewart Street Area
Sunnyside
Thankerton
Thorndean
West End Scheme
Wrangholm
Laburnum Road
Redwood
Crescent Area
Tannochside
Viewpark Electric
Scheme
Clay Road /
Carnbroe
Clyde / Douglas
Drive Area
Coronaon Road
Area
Crohead
Dean Street
Freestate
Glebe Street
Haonrigg
Holytown Electric
Scheme
Holytown Main
Street
Jewel Scheme
Liberty Road Area
Birkenshaw
Burnhead
Fallside
Glenburn /
Limetree
Clyde Valley
Housing Associaon
Lanarkshire Housing
Associaon Ltd
North Lanarkshire
Council
West of Scotland
Housing Associaon
Santcuary Scotland
Housing Associaon
Cairn Housing
Associaon
Garrion Housing
Co-operave
Forgewood Housing
Co-operave Ltd
If you need further help with this please contact any of the partner landlords.
Wishaw and District
Housing
22 HOUSING APPLICATION FORM
Auchinloch Mollinsburn
Mount Ellen
Muirhead
Old Moodiesburn
Moodiesburn
Electric Scheme
Moodiesburn
Main Scheme
Cardowan / Stepps
Chryston
Crowwood
Gartcosh
Garerry
Millerston
Brandon Muirhouse
Caldergrove New Forgewood
Carn North Lodge
Coursington North Motherwell
Daisypark Old Forgewood
Flemington Parkneuk
Higheld Ravenscraig North
Hillhead Tillanburn
Jerviston Woodilee
Ladywell Ye
Laughlan Drive Area
Motherwell
Moodiesburn
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
Clyde Valley
Housing Associaon
Lanarkshire Housing
Associaon Ltd
North Lanarkshire
Council
West of Scotland
Housing Associaon
Santcuary Scotland
Housing Associaon
Cairn Housing
Associaon
Garrion Housing
Co-operave
Forgewood Housing
Co-operave Ltd
If you need further help with this please contact any of the partner landlords.
Wishaw and District
Housing
HOUSING APPLICATION FORM 23
Kilsyth
Wishaw
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X
Balmalloch
Newton /
Park Drive
Northwood Drive
Omoa Road
Parkside
Princess Square
Shand Street
Stewart Crescent
Tinto
Waterloo
West Crindledyke
Whitestripe
Alexander Street
Bellside
Bonkle
Braedale
Branchalmuir
Dimsdale
Eastwood
Fraser Street
Gowkthrapple
Greenhead
Lithgow Drive /
Chapel Street
Manse Road Timber
Houses
Kilsyth Central
Kirklands Crescent
Queenzieburn
Rennie Road /
Northeld
Banton
Barwood
Croy
Fisher / Manse
Road Area
Wishawhill
West Coltness
Pather
Overtown
Netherton
East Coltness
Craigneuk
Central Wishaw
Cambusnethan
Alcath
Clyde Valley
Housing Associaon
Lanarkshire Housing
Associaon Ltd
North Lanarkshire
Council
West of Scotland
Housing Associaon
Santcuary Scotland
Housing Associaon
Cairn Housing
Associaon
Garrion Housing
Co-operave
Forgewood Housing
Co-operave Ltd
If you need further help with this please contact any of the partner landlords.
Wishaw and District
Housing
24 HOUSING APPLICATION FORM
Shos
Coatbridge
Allanton School
Scheme
Bargeddie
Glenboig
Old Monkland
Shawhead etc
Sikeside / Greenend
Greenhill
Kirkshaws
Kirkwood
Barroweld /
Whiet
Carnbroe
Coatbridge
Summerlee /
Gartsherrie
Townhead /
Espieside
Clionhill /
Clionville /
Sunnyside
Langloan/
Dundyvan/Allan St
Development
Northeld
Parkside Road
Quarry Street
Shos
Springhill Road
St Catherine’s
Stane
Torbothie
Tulloch Road
Vennacher Street
Allanton Village
Burnside
Easield
Garden City
Harthill Village
Hunter Street
Harthill School
Scheme
If desired, please mark with a 1 or an X If desired, please mark with a 1 or an X
If desired, please mark with a 1 or an X If desired, please mark with a 1 or an X
Clyde Valley
Housing Associaon
Lanarkshire Housing
Associaon Ltd
North Lanarkshire
Council
West of Scotland
Housing Associaon
Santcuary Scotland
Housing Associaon
Cairn Housing
Associaon
Garrion Housing
Co-operave
Forgewood Housing
Co-operave Ltd
If you need further help with this please contact any of the partner landlords.
Wishaw and District
Housing
HOUSING APPLICATION FORM 25
Yes
Yes
Yes
Yes
Yes
Problems with neighbours
The Police
Your landlord or housing oce
Other (please say)
The councils’ ansocial response service
Racial harassment Serious ansocial behaviour
Yes
No
No
No
No
No
No
5e Are you interested in a mutual exchange?
5f Are you interested in shared ownership with a housing as sociation?
Section 6 Harassment or disturbance
If you suer from harassment or disturbance where you are currently living, please ll in secon 6 to
tell us about it.
If you want to discuss these issues in more details, please contact your landlord.
6a Are any members of your household experiencing disturbance or harassment?
6b If you have answered ‘Yes’ please tick any of the following that apply.
6c Have you reported any of the incidents?
6d If you have answered yes, who have you reported the incidents to?
6e Has anyone ever taken action against you or anyone on your application for
antisocial behaviour?
If you have answered Yes to queson 5e please choose if you want to be contacted direct from other
interested tenants , or if you would rather only be contacted by CHR Partner Landlords.
Please add my name, address, contact telephone numbers(s), email address and a note of any areas
I do not wish to be considered for to the mutual exchange list which is viewable by all CHR Partners
and members of the public
Please add me to the mutual exchange list, however i only wish to be contacted by a member of sta
from a CHR Partner Landlord
Further details on our mutual exchange process can be found on the councils website
www.northlanarkshire.gov.uk
Please explain in more detail
Yes No
26 HOUSING APPLICATION FORM
6f If you have answered ‘Yes’ was this court action?
6g Please give the full name of the person or people the action was taken against.
6h Or, was the action less formal (such as a warning)
6i Please tell us what action was taken.
6j Please give the full name of the person or people the action was taken against.
6k Have you or anyone on your application received an antisocial behaviour order
(ASBO)?
6l If you have answered ‘Yes’, please give their full name.
6m Are you, or anyone seeking to be housed with you, required to register with
the police under the Sexual Offences Act 2003?
Yes
Yes
Yes
No
No
No
HOUSING APPLICATION FORM 27
Section 7 Your relationships to staff, councillors and committees
If you are related to any member of sta, an elected member of the council or a commiee member
of any of the partner landlords, it is important that you let us know so that we can keep to the
relevant condions of the Housing (Scotland) Act 2001.
This will not aect your right to be considered for housing.
7a Are you, or anyone you want to be rehoused with, closely related to any
councillor or member of the management committee (who manage registered
social landlords), or to any employee of the partner landlords of the North
Lanarkshire Common Housing Register?
Close relaves mean husband, wife, partner, father, mother, grandfather, grandmother, sister,
brother, son, daughter, (including step-relaves, in-laws and partners relaves), aunt, uncle, niece,
nephew or cousin.
This informaon will not aect your applicaon in any way, but we need it to keep to the condions
of the Housing (Scotland) Act 2001, and to ensure our services are transparent.
7b Do you or anyone you want to be rehoused with work for any of the following?
The council’s housing service
A housing associaon or co-operave
Name of person
Name of person
Relationship (for
example, husband)
Name of the committee
member, councillor or
employee the person is
related to
Name of organisation they work for
Name of the organisation
they work for?example,
husband)
Yes
Yes
No
No
28 HOUSING APPLICATION FORM
Declaration
Please read through the following statements and sign at the boom to show that you understand
and agree with them.
I agree:
• I have read and understand the secon on the Data Protecon Act 2018 and the Common Housing Register Privacy
Statement.
• That you may process my/our personal data as in the aforemenoned statement, including contacng my/our
current/previous landlords, my/our doctor, hospital consultant, health visitor, social worker, police, probaon ocer
or any other relevant person if more informaon is needed in connecon with my/our housing applicaon.
• That the Council can share my/our personal data with other social housing providers if I/we are nominated for
housing through the Council’s Nominaon Agreements.
• That I/we will inform the North Lanarkshire CHR of any change in circumstances.
• That all informaon given by me/us to the North Lanarkshire CHR is true and accurate. If I/we supply any false
informaon or do not tell you about any relevant informaon, you may suspend my applicaon.
• That if I/we are given a tenancy because I/we have supplied false informaon or I/we have held back any informaon
that the landlord will take acon to end the tenancy.
• If I/we accept a property oered through the North Lanarkshire CHR including mutual exchange, and nominaon to
other social housing providers that my/our applicaon will be cancelled and that I/we will have to submit a fresh
applicaon if I/we wish to move again.
Signing this declaraon will allow us to process your applicaon. (If you require further informaon to help you with this
please contact any of the partner landlords whose details are on the back page of the form).
Why are you lling this form in for the applicant?
Date
Signature
Contact number
Postcode
Adddress
Name
Joint Applicant Signature: Date:
Applicant Signature: Date:
Application filled in on behalf of the person applying
If this form has been lled in by someone other than the person applying, please tell us your name
and address and why you are lling in this for the applicant.
If you are compleng this applicaon on behalf of someone for whom you have been granted Power
of Aorney or Guardianship, copies of the relevant documentaon should be submied along with
the applicaon.
HOUSING APPLICATION FORM 29
North Lanarkshire Common Housing Register - Confidential Survey
The common housing register partnership aims to encourage equal opportunies and diversity, responding to
your dierent needs, whatever your sex, disability, age, naonality, marital status, ethnic background,
religious beliefs, sexuality or gender re-assignment (becoming legally recognised as the opposite sex to that
shown on your birth cercate).
You do not have to ll in the following informaon. This informaon will not aect your housing applicaon.
Please choose one secon from A to E then ck one box which best describes your ethnic group or
background.
Yes Yes
Northern Irish Northern Irish
Welsh Welsh
English English
Scosh Scosh
A White A White
Main applicant Joint applicant
Arab Arab
Other, please write in. Other, please write in.
Black, Black Scosh or Black Brish Black, Black Scosh or Black Brish
Caribbean, Caribbean Scosh or Caribbean Brish Caribbean, Caribbean Scosh or Caribbean Brish
African, African Scosh or African Brish African, African Scosh or African Brish
D African, Caribbean or Black D African, Caribbean or Black
Other, please write in. Other, please write in.
Chinese, Chinese Scosh or Chinese Brish Chinese, Chinese Scosh or Chinese Brish
or Bangladeshi Brish or Bangladeshi Brish
Bangladeshi, Bangladeshi Scosh Bangladeshi, Bangladeshi Scosh
Indian, Indian Scosh or Indian Brish Indian, Indian Scosh or Indian Brish
Pakistani, Pakistani Scosh or Pakistani Brish Pakistani, Pakistani Scosh or Pakistani Brish
C Asian, Asian Scosh or Asian Brish C Asian, Asian Scosh or Asian Brish
Any mixed or mulple ethnic groups, please write in. Any mixed or mulple ethnic groups, please write in.
Any other white ethnic group, please write in. Any other white ethnic group, please write in.
B Mixed or mulple ethnic groups B Mixed or mulple ethnic groups
Do you consider yourself to have a disability? Do you consider yourself to have a disability?
Other, please write in. Other, please write in.
Disability Disability
E Other ethnic group E Other ethnic group
No No
Polish Polish
Gypsy/Traveller Gypsy/Traveller
Irish Irish
Brish Brish
30 HOUSING APPLICATION FORM
CHR Partner Landlord Contact Information
Cairn Housing Association
5 Linnet Way
Strathclyde Business Park
Bellshill ML4 3RA
Phone: 0800 990 3405
Clyde Valley Housing Association
50 Sco Street
Motherwell ML1 1PN
Phone: 01698 268855
Forgewood Housing Co-operative
Forgewood Community Centre
49 Dinmont Crescent
Motherwell ML1 3TT
Phone: 01698 263311
Garrion People’s Housing Co-operative
Centre Point
70 Smith Avenue
Gowkthrapple
Wishaw ML2 0LD
Phone: 01698 687222
Lanarkshire Housing Association
191 Brandon Street
Motherwell ML1 1RS
Phone: 01698 269119
Sanctuary Scotland Housing
Association
Fleming House 8th Floor
2 Tryst Road
Cumbernauld G67 1JW
Phone: 0800 131 3348
West of Scotland Housing As sociation
Camlachie House
40 Barroweld Drive
Camlachie
Glasgow G40 3QH
Phone: 0141 550 5600
Wishaw and District Housing
Part of Trust Housing Associaon
55 Kirk Road
Wishaw ML2 7BL
Phone: 01698 377200
North Lanarkshire Council
Airdrie Housing Oce
1st Floor Coats House
40 Gartlea Road
Airdrie ML6 9JA
Phone: 01236 758035
North Lanarkshire Council
26 Motherwell Road
Bellshill ML4 1RE
Phone: 01698 332340
North Lanarkshire Council
Coatbridge Housing Oce,
Buchanan Centre,
126 Main Street,
Coatbridge ML5 3BJ
Tel 01236 812561
North Lanarkshire Council
Cumbernauld First Stop Shop
Ground Floor, Fleming House
2 Tryst Road
Cumbernauld G67 1JW
Phone: 01236 856254
North Lanarkshire Council
9 Parkfoot Street
Kilsyth G65 9AA
Phone: 01236 828120
North Lanarkshire Council
17 Blackwoods Crescent
Moodiesburn G69 0EZ
Phone: 01236 638888
North Lanarkshire Council
Motherwell First Stop Shop
Dalziel Building
7 Sco Street
Motherwell ML1 1SX
Phone: 01698 274135
North Lanarkshire Council
162 Staon Road
Shos ML7 4AW
Phone: 01501 824747
North Lanarkshire Council
Wishaw First Stop Shop
Houldsworth Centre
Kenilworth Avenue
Wishaw ML2 7LP
Phone: 01698 302920
CC_2020 00101
North Lanarkshire Council and registered social landlords working in
partnership to provide:
• a simple process for applying for housing;
• one application form to ll in for all partner landlords;
• good quality housing options information and advice.
This application form can be explained to you in another language, or
supplied in large print or other format, please contact us to discuss
your needs.