Housing Application - Coopérative Rochelandaise

Need help or do you have any questions?

Do you prefer to fill out this form on paper?

Download and print the form

Return to the homepage

Housing request

Please enable JavaScript in your browser to complete this form.

Step 1 of 7

Choice of housing

2-bedroom unit
3-bedroom unit
Adapted unit (reserved for existing members)

Candidate No. 1

Candidate name no. 1

First

Last

Date of birth

Phone

E-mail

Candidate No. 2

Candidate name no. 2

First

Last

Date of birth

Phone

E-mail

Your current address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Employment information

Current employer

Company name

Employer's address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Position held

Name of your superior

Annual income

Employment status

Full-time
Part-time work
Permanent

Employed since

Number of hours per week

Phone

Previous employer

Company name

Employer's address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Position held

Name of your superior

Annual income

Employment status

Full-time
Part-time work
Permanent

Employed since

Number of hours per week

Phone

Banking information

Name of banking institution

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Number of cars

References

Candidate no. 1

Name

Phone

Link

Candidate no. 2

Name

Phone

Link

Need help or do you have any questions?

Do you prefer to fill out this form on paper?

Candidate No. 1

Candidate No. 2

Child's name and age

Employment information

Current employer

Previous employer

Banking information

References

Candidate no. 1

Candidate no. 2

Declaration

Initials