Live and Work Application Form

Step 1 of 6 - Personal Details

16%

Application Number(Required)

Please enter your temporary application number. You will have received this through email through your initial enquiry. If you do not have a temporary application number, please click the "More information" button above to apply and receive one. Applications without a temporary application number will NOT be prioritised.

Full Name(Required)

Date of Birth(Required)

YYYY slash MM slash DD

Address(Required)

Street Address City Postcode

Telephone(Required)

Email(Required)

Gender(Required)

Current accommodation(Required)

Please confirm you are a single occupant only.(Required)

I am a single occupant

If you are a couple and are both interested in moving, please complete an application form each.

Employment(Required)

Are you interested in an NHS apprenticeship?(Required)

Yes

Current job title(Required)

Current employer's company name(Required)

Current hours worked per week(Required)

Monthly salary (in £)(Required)

Length of time employed at your current workplace(Required)

Were you employed previous to your current working/studying status?(Required)

Yes

Previous job title(Required)

Previous company name(Required)

Were you with your previous company full or part time?(Required)

Previous hours worked per week(Required)

Previous monthly salary (in £)(Required)

Length of time with previous employer (in months)(Required)

Please upload your most recent proof of employment. This could be a wage slip, contract, or HMRC employment history.(Required)

Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 1 MB.

Are you at university or college?(Required)

Yes

Are you studying full or part time?(Required)

Hours of study per week(Required)

Length of course(Required)

Time remaining until completion of course(Required)

Location/university/college name(Required)

Please upload proof of student status (this could be a confirmation of Study letter from your University or College, or student status certificate).(Required)

Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 1 MB.

Do you have a previous address?(Required)

Yes

Previous Accommodation(Required)

Previous residential address(Required)

Date from(Required)

YYYY slash MM slash DD

Date to(Required)

YYYY slash MM slash DD

Relationship to landlord(Required)

Do you have any outstanding rent arrears?(Required)

Yes

How much do you owe in rent arrears (in £)(Required)

Do you have a payment agreement in place for your rent arrears?(Required)

Yes

Do you have any support from money/ debt management agencies? If so, please provide agency name(Required)

Reason for leaving accommodation(Required)

Do you have any physical or mental health conditions?(Required)

Yes

Name of mental or physical health condition(s)(Required)

Medication taken (if any)(Required)

Please tell us about any external support you receive for your mental or physical health conditions(Required)

Do you have a local connection to Sandwell?(Required)

Parents

Grandparents

Friends/family

Other

I have no connection to Sandwell

A local connection is not critical to your application

Do you work or study in Sandwell?(Required)

I work in Sandwell

I study in Sandwell

Please tell us why you have applied to the Live & Work Scheme(Required)

How did you hear about Live and Work at Sandwell?(Required)

Internet search

Friends

Social media

Support worker

Local authority housing team

Sandwell NHS

St Basils website

Other

In your own words, please tell us why you would like to live at Live and Work(Required)

You can tell us about past experiences, your future hopes and what you would like to get out of the scheme

Electronic Signature(Required)

Type your full name to consent to your data being processed by St Basils for the purposes of Live and Work

Apply for Live and Work

You have been invited to apply for our innovative and award-winning project in Sandwell, offering Apprenticeships and affordable rents with support to any young person, whether they have been homeless or not.

Eligibility

Live and Work Application Form