Apply - Launchpad

About you

Title

Please State Title

First Name*

Last Name*

Marital Status*

Is this a joint application (with a partner)?*

Do you have any dependent children, if so how many?

Preferred location*

Are you from:*

Please state where you are from*

Date of birth (DD/MM/YYYY)*

National Insurance Number

Email address (if you have one)

Landline telephone number (if you have one)

Mobile phone number (if you have one)

Do you have any convictions? If so, please state

Your current living arrangements

Current address (please include postcode)*

Street Address Address Line 2 City County Postal Code Country

What is your current accommodation arrangement?*

What was the name of your previous landlord (if relevant)?

What was the phone number of your previous landlord (if relevant)?

What was the address of your previous landlord (if relevant)?

Street Address Address Line 2 City County Postal Code Country

Do you receive housing benefit?

If yes, for all or part of your rent?

What benefits are you currently receiving?

Employment and Support Allowance (ESA)
Job Seekers Allowance (JSA)
Universal Credit (UC)
Personal Independence Payment (PIP)
Other
Not sure

Please state what benefit(s) you are currently receiving*

Do you have any support needs? If so, please give more details.

About your time in the military

From which service have you come?*

State which service you are from*

Service Number:*

Date of enlistment*

Tick the relevant box if you are still serving

Regular unit / base / ship
Reserve unit / base / ship

Date of discharge*

Reason for discharge?*

Rank on discharge?*

Which Regt or Corps were you in (Army only)?

Location of last unit

About work and training

What is your employment status?*

Are you:

Please tick the relevant box if you are part of any of these schemes or organisations:

RBL’s Civvy Street
Future Horizons Programme
CTP (MOD’s Career Transition Partnership)
RFEA

Do you receive support from any other charities/agencies? If so, please tell us.

Do you have any training / employment needs?

If you are self-employed, please describe your business

Do you need local business premises?

Disability

Do you consider yourself to have a disability?

If yes, please provide details

Are you, as the qualifying applicant, registered disabled?

If you are making a joint application, is your partner registered disabled?

War Pension Disability Percentage

If yes, please tell us XX%

If you, or any person named in this application have any medical conditions which would affect your housing needs that you would like us to consider when assessing your application (i.e. unable to negotiate stairs etc), please give full details, if appropriate.

Data Protection & Declaration

AF&V Launchpad Limited (Launchpad) will use the information you have provided on this form (called ‘Personal Data’ in the Act) onto its computer system and it will be processed for the purposes of helping you. Launchpad may give your information to any agency or person(s) for this purpose. Launchpad may also use your information for its own research purposes (but not for direct marketing). Launchpad is the “data controller” for this information. You have a right to ask us for a copy of your information, and for a description of how it is being used and to whom it may be given.

Declaration – I confirm that, as far as I know, the information I have given in connection with this application for housing is correct. I will inform you immediately if there are any changes to my circumstances. I give you permission to make any reasonable enquiries to clarify and confirm the details I have given on this form.

Mandate – I give Launchpad permission to make enquiries they consider necessary with other agencies or persons for the assessment of my application for housing. I also agree to the release by such agencies or persons of the information sought. I declare that the answers I have given are a true statement of my whole circumstances and I also note that any false or misleading information provided on my application form, or in personal interview or correspondence, may result in the cancellation of my application for housing through Launchpad.

Sign to say "I agree with the above declaration and would like my application considered without delay"*

Date

References

We require a reference from a responsible person or referral agency. We also accept self-referrals.

If you are using a referee or referral, this should ideally be your current (or most recent) Subunit or Unit Commander (employer and your current (or most recent) landlord or a Minister, Doctor, Lawyer, or Official of your Regimental Association etc). The reference must NOT be from a relative or friend. A reference from an agency or charity should provide a named point of contact.

Name or agency point of contact who’ll act as a referee*

(if self-referring, please complete your full name)

Referral agency name / title*

Position or current appointment held of the referee*

Address of referee*

Street Address Address Line 2 City County Postal Code Country

Contact number*

Email address*

Consent*

I agree to the Veterans Launchpad terms and privacy policy.

By submitting this form you are happy for your information to be passed onto the relevant personnel within Launchpad, who will process the application.

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