HOMESHARER APPLICATION FORM

PLEASE READ

TERMS & CONDITIONS
By completing and submitting this application form you are agreeing to our Homesharer Terms & Conditions.

REFERENCES
To Avoid delays processing your application we recommend that you have the contact details of two referees to hand in support of your application.

HOMESHARER PERSONAL INFORMATION

IMPORTANT INSTRUCTIONS
PLEASE COMPLETE *(Required) FIELDS AND CLICK SUBMIT AT THE END OF THIS FORM.
*ALTERNATIVELY, CLICK SAVE AND RESUME LATER.

PLEASE SELECT APPLICATION TYPE: (Required)

HOMESHARER
HOMESHARER PLUS

IMPORTANT INFORMATION:

1. HOMESHARER is Regular Homeshare Arrangement in which you provide between 10 to 15 hours of combined Companionship and General Support to a Household Homeshare Host each per week. With this arrangement you pay a fee of £190 per month which covers the cost of your Homeshare Arrangement.

2. HOMESHARER PLUS is an enhanced Homeshare Arrangement in which you provide between 20 to 25 hours of combined Companionship and General Support to a Householder Homeshare Host each week. With this arrangement YOU DO NOT PAY any monthly fees and in addition to provision of accommodation and cost of utility bill covered (fair usage policy applies), you are also given a reasonable allowance to cover your weekly/monthly food costs.

FULL NAME (Required)

First

Last

GENDER (Required)

FEMALE
MALE
OTHER

DATE OF BIRTH (Required)

PHONE (Required)

EMAIL ADDRESS (Required)

ETHNICITY

FAITH

ADDRESS (Required)

Address Line 1

City

State / Province / Region

Postal Code

Country

INFORMATION: Address Auto-Lookup and Auto Complete is available in this section.

PHOTOGRAPH ID (Required)

Click or drag a file to this area to upload.

Please Provide ONE Recent Photograph of Yourself for Internal Identification Purposes. THE PICTURE MUST NOT BE MORE THAN 10MB IN SIZE AND BE IN EITHER ONE OF THE FOLLOWING FORMATS:

PNG
GIF
JPEG
TIFF
RAW
PSD

HOMESHARER HEALTH & WELLBEING DISCLOSURE

IMPORTANT INFORMATION - PLEASE READ CAREFULLY

Please tell us about any health and wellbeing conditions.

HOMESHARER HEALTH & WELLBEING DISCLOSURE (Required)

I DO NOT SUFFER FROM ANY PHYSICAL OR MENTAL HEALTH CONDITIONS THAT WOULD IMPEDE MY ABILITY TO FULFIL A HOMESHARERS RESPONSIBILITIES
I WOULD LIKE TO DISCLOSE A PHYSICAL OR MENTAL HEALTH CONDITION

IMPORTANT INFORMATION

As part of the Supportmatch Homeshare Arrangement, it is essential to confirm that you are fully capable of providing the necessary companionship and practical support to the Householder you may be matched with.

Please select one of the following options, to either confirm that you do not suffer from any physical or mental health conditions that would impede your ability to fulfil these responsibilities effectively, or that you would like to disclose a health and wellbeing condition.

HEALTH CONDITIONS DISCLOSURE (Required)

Please select Health Conditions relevant to you.

OTHER HEALTH CONDITIONS NOT LISTED ABOVE

EMERGENCY CONTACT OR NEXT OF KIN (NOK)

We Recommend that Homesharers provide an Emergency Contact.

NOK Full Name (Required)

NOK Full Address (Required)

Address Line 1

City

State / Province / Region

Postal Code

Country

NOK Phone (Required)

NOK Email Address (Required)

NOK Relationship to Householder (Required)

RELATIVE
FRIEND
OTHER

ABOUT YOU

PLEASE TELL US ABOUT YOUR INTERESTS, HOBBIES, PERSONALITY, LIKES, DISLIKES, TOLERANCES AND GENERAL NATURE (Required)

This section is important and will greatly help us to initially determine the best fit Homeshare match that will takes into account your personality, background, interests and future plans. We will further refine your requirements, preferences and profile in follow-up discussions we have with you.

DO YOU CURRENTLY WORK OR STUDY (Required)

YES
NO

JOB/COURSE TITLE (Required)

WORK/STUDY DAYS (Required)

HOURS PER WEEK (Required)

EMPLOYER/INSTITUTION NAME (Required)

EMPLOYER/INSTITUTION ADDRESS (Required)

Address Line 1

City

State / Province / Region

Postal Code

Country

Note: Address Auto-Lookup and Auto Complete is available in this section.

YOUR UK STATUS

ARE YOU CURRENTLY IN THE UK (Required)

YES
NO

If you are not in the UK at the moment let us know when you intend to arrive..

Initial introductions and Meetings can be arranged via Video Conference through Supportmatch.

YOUR CURRENT COUNTRY LOCATION (Required)

DATE YOU EXPECT TO ARRIVE IN THE UK (Required)

Please tell us when you will be returning to the UK so that we can determine when you will be available to meet with potential Householders you match.

ARE YOU A UK RESIDENT (Required)

YES
NO

VISA TYPE / NATURE OF STAY IN THE UK (Required)

DATE UK VISA EXPIRES (Required)

Please provide us with the date your UK VISA Expires.

BACKGROUND CHECKS

DO YOU HAVE A CURRENT UP-TO-DATE DBS CERTIFICATE (Required)

YES
NO

WHAT IS A DBS CHECK:

A DBS check is a process used to search through an individual’s criminal record and highlights any offences.

DBS CERTIFICATE YOU HAVE (Required)

STANDARD DBS CERTIFICATE
ENHANCED DBS CERTIFICATE
I DONT KNOW

REFERENCES: YOUR REFEREES

Please provide at details of your referees for references. FIRST TWO REFERENCES must be from professional, work or study sources. The THIRD REFERENCE can be a Long Term FRIEND but NOT A FAMILY MEMBER.

REFEREE 1: FULL NAME (Required)

Work or Academic Referee

REFEREE 1: EMAIL ADDRESS (Required)

REFEREE 1: PHONE

REFEREE 2: FULL NAME (Required)

Work or Academic Referee

REFEREE 2: EMAIL ADDRESS (Required)

REFEREE2: PHONE

REFEREE 3: FULL NAME

OPTIONAL: Close Friend

REFEREE 3: EMAIL ADDRESS

OPTIONAL

REFEREE 3: PHONE

HELP & SUPPORT YOU ARE ABLE TO GIVE A HOUSEHOLDER IN EXCHANGE FOR AFFORDABLE ACCOMMODATION

Please pick from the multi-select dropdown menut below.

HELP & SUPPORT (Required)

Please select the help and support you can comfortably offer a Householder in need of Companionship and Support in Exchange for Affordable Accommodation.

LIKELY TIMINGS (Required)

Daytime
Evenings
Weekdays
Weekends

Likely Timings when you are able to offer the Householder Support and Companionship.

LIKELY WEEK DAYS (Required)

Days you are most likely to be available to offer the Support and Companionship.

IMPORTANT: HOMESHARERS ARE NOT PERMITTED TO PROVIDE PERSONAL OR PROFESSIONAL CARER SERVICES (Please Tick Box to Confirm You Understand) (Required)

I CONFIRM I UNDERSTAND THAT NO PERSONAL CARE IS TO BE PROVIDED TO THE HOUSEHOLDER UNDER HOMESHARE ARRANGEMENT

HOMESHARER SUPPORT DOES NOT INCLUDE OVERNIGHT ATTENDANCE SUPPORT OR PERSONAL CARE.

Homesharer Support and Companionship does not include night-time Attendance Support or Personal Care. Homesharers will cover Normal Emergency Situations that may occur in the Household during the time/period they are in the property. Such Normal Emergencies would include, if required, contacting emergency services and family members. If you have any questions or concerns please call 0203 633 6066 to discuss this with a Supportmatch Homeshare Coordinator.

DO YOU HAVE ANY HOMESHARE EXPERIENCE (Required)

YES
NO
INFORMALLY

PLEASE PROVIDE INFORMATION ABOUT YOUR HOMESHARE EXPERIENCE (Required)

WHEN DO YOU NEED ACCOMMODATION FROM (Required)

ASAP
WITHIN 1 MONTH
WITHIN 3 MONTHS
FLEXIBLE

DO YOU NEED TO GIVE NOTICE WHERE YOU ARE LIVING (Required)

YES
NO
NOT APPLICABLE

HOW MUCH NOTICE DO YOU NEED TO GIVE (Required)

ONE WEEK
ONE MONTH
THREE OR MORE MONTHS
OTHER

DO YOU HAVE FAMILY OR FRIENDS IN THE UK WHO COULD ACT AS A SOURCE OF SUPPORT FOR YOU (Required)

YES
NO

LIVING PREFERENCES & LOCATIONS

I PREFER TO HOMESHARE WITH A (Required)

MALE
FEMALE
COUPLE
NO PREFERENCE

ARE YOU A SMOKER (Required)

YES
NO

COULD YOU LIVE WITH A SMOKER (Required)

YES
NO
IT DEPENDS

DO YOU HAVE ANY PETS (Required)

YES
NO

COULD YOU HOMESHARE WITH A HOUSEHOLDER WHO HAS A PET (Required)

YES
NO
IT DEPENDS

PREFERED LIVING LOCATIONS

Please Select Three Cities/Towns where you would prefer to live. If your preference is for just one location then select that location across all three options.

1ST CHOICE (City/Town) (Required)

2ND CHOICE (City/Town) (Required)

3RD CHOICE (City/Town) (Required)

ACKNOWLEDGMENT & AGREEMENT

Once Matched, To pay a non-refundable matching and registration fee of £60
Once Matched, Agree to pay a monthly fee of £190.00 per month for a single person under Regular Homeshare, £360.00 per month for a Couple under Regular Homeshare, Or to pay a one-off matching fee of £200 if you are applying for Homeshare Plus.
To respect and abide by our Terms & Conditions and Agreement if you are matched with a suitable Householder.
Allow us to use your Data and Information to process your application and to facilitate the Matching, Monitoring and Management of any Homeshare Arrangement you enter into with us.
Before Being Matched, To either provide us with a copy of an Up-To-Date Enhanced DBS Certificate or complete a DBS application through us.

ACKNOWLEDGEMENT & AGREEMENT (Required)

YES I AGREE TO THE TERMS AND CONDITIONS IN THIS APPLICATION
NO I DO NOT AGREE

PLEASE READ TERMS & CONDITIONS By completing and submitting this application form you are agreeing to our Homesharer Terms & Conditions.

REFERENCES To Avoid delays processing your application we recommend that you have the contact details of two referees to hand in support of your application.

HOMESHARER PERSONAL INFORMATION

IMPORTANT INSTRUCTIONS

PLEASE COMPLETE *(Required) FIELDS AND CLICK SUBMIT AT THE END OF THIS FORM.

*ALTERNATIVELY, CLICK SAVE AND RESUME LATER.

THE PICTURE MUST NOT BE MORE THAN 10MB IN SIZE AND BE IN EITHER ONE OF THE FOLLOWING FORMATS: PNG GIF JPEG TIFF RAW PSD

HOMESHARER HEALTH & WELLBEING DISCLOSURE

IMPORTANT INFORMATION - PLEASE READ CAREFULLY

IMPORTANT INFORMATION

EMERGENCY CONTACT OR NEXT OF KIN (NOK)

ABOUT YOU

YOUR UK STATUS

BACKGROUND CHECKS

REFERENCES: YOUR REFEREES

HELP & SUPPORT YOU ARE ABLE TO GIVE A HOUSEHOLDER IN EXCHANGE FOR AFFORDABLE ACCOMMODATION

HOMESHARER SUPPORT DOES NOT INCLUDE OVERNIGHT ATTENDANCE SUPPORT OR PERSONAL CARE.

LIVING PREFERENCES & LOCATIONS

PREFERED LIVING LOCATIONS

ACKNOWLEDGMENT & AGREEMENT

PLEASE READ

TERMS & CONDITIONS
By completing and submitting this application form you are agreeing to our Homesharer Terms & Conditions.

REFERENCES
To Avoid delays processing your application we recommend that you have the contact details of two referees to hand in support of your application.

THE PICTURE MUST NOT BE MORE THAN 10MB IN SIZE AND BE IN EITHER ONE OF THE FOLLOWING FORMATS:

PNG
GIF
JPEG
TIFF
RAW
PSD