[[[["field24","equal_to","No"]],[["show_fields","field25"]],"and"],[[["field38","equal_to","Yes"]],[["show_fields","field30,field31,field32,field33,field34,field35,field36,field37,field106,field107,field111,field112,field113,field108,field109,field110,field137,field138,field139,field140,field141,field142,field143,field144,field145,field147,field152,field167,field116,field256"]],"and"],[[["field183","equal_to","Yes"]],[["show_fields","field188,field190,field191,field192,field194,field195,field196,field199,field200,field201,field202,field206,field203,field208,field204,field207,field209,field210,field211,field212,field213,field214"]],"and"],[[["field217","equal_to","Yes"]],[["show_fields","field218"]],"and"],[[["field219","equal_to","Yes"]],[["show_fields","field221"]],"and"],[[["field228","equal_to","Other"]],[["show_fields","field229"]],"and"],[[["field223","equal_to","Yes"]],[["show_fields","field225,field226,field227,field228,field229,field231,field232,field233"]],"and"],[[["field41","equal_to","Yes"]],[["show_fields","field42,field43,field44,field45,field46,field47,field48,field49,field50,field51,field52,field53,field54,field55,field56,field57"]],"and"],[[["field60","equal_to","Yes"]],[["show_fields","field61,field62,field63,field64,field65,field66,field67,field68,field69,field70,field71,field72,field73,field74,field75,field76"]],"and"],[[["field78","equal_to","Other"]],[["show_fields","field79"]],"and"],[[["field83","equal_to","Yes"]],[["show_fields","field85"]],"and"]]
1 Step 1
Aldebrain Tower

ADMINISTRATIVE OFFICE

2155 Lawrence Avenue East, Scarborough, Ontario, Canada, M1R 5G9

Telephone: (416) 285-5447 | Fax: 416-285-1057

Part A: Date of Application
Part B: Housing Needs
Number of Bedrooms
Part C: Name & Address
Part D: S.I.N. & Citizenship & Marital Status
Are you a Canadian Citizen?
Marital Status
Part E: Co-Applicant(s)
Do you have any co-applicant(s)?
Sex
Sex
Part F: Child(ren)
Do you have any children?
Sex
Sex
Sex
Sex
Part G: Family Member(s)
Will there be other family members residing in the accommodation being applied for?
Sex
Sex
Sex
Sex
Part H: Present Accommodations
How many bedrooms?
Do you have rent subsidy?
Do you have a lease?
Cost of Accommodation
Part I: Current Landlord(s)
How long have you been at your current address?
How long has the co-applicant been at their current address?
Part J: Previous Addresses
Applicant
AddressFromToReason For Leaving
×
(1)
Co-Applicant
AddressFromToReason For Leaving
×
(1)
Part K: Present Employer
Part L: Previous Employment History
Applicant's Employment History
EmployerPositionFromTo
×
(1)
Co-Applicant's Employment History
EmployerPositionFromTo
×
(1)
Part M: Household Income
Please enter the gross monthly amount received (before deductions) from each applicable source:
Applicant's Sources of IncomeAll amounts in CAD
Court SettlementDisability InsuranceEmploymentFamily Benefits AllowanceGeneral Welfare AssistanceOld Age SecurityInterest on Personal SavingsUnemployment InsuranceOther -Specify
×
(1)
Co-applicant's Sources of IncomeAll amounts in CAD
Court SettlementDisability InsuranceEmploymentFamily Benefits AllowanceGeneral Welfare AssistanceOld Age SecurityInterest on Personal SavingsUnemployment InsuranceOther -Specify
×
(1)
Other Household Members' Sources of IncomeAll amounts in CAD
Court SettlementDisability InsuranceEmploymentFamily Benefits AllowanceGeneral Welfare AssistanceOld Age SecurityInterest on Personal SavingsUnemployment InsuranceOther -Specify
×
(1)
Part N: Child Care Expense
For employed applicants or applicants attending an educational institute on a full-time basis
Part O: Social Assistance
Complete only if in receipt of municipal welfare or family benefits
Part P: Assets
Do you have any assets?
For all the assets that you own from the list below, please state the approximate values (amounts) and the amount of additional monthly income (if any) that they generate (e.g. interest, annuities, dividends)
Bank Accounts
Trust Companies/ Credit Unions
Bonds/ Saving Certificates
Annuities/ Shares/ Securities/ Stocks
Real Estate
Business Interest
Part Q: Bank/ Property/ Business
Name of BankAddressAccount TypeAccount#Balance ($)
×
(1)
Do you own any property?
Do you have an interest in a business?
Part R: Pets
Do you own any pets?
Does your pet(s) wear an identification tag and collar?
Is your pet(s) licensed in accordance with the City of Scarborough By-Law Number 22992?
Has your pet(s) received their annual shots and vaccines?
What kind of pet(s) do you own?
How many pets do you presently own?
Please provide a detailed list with the name of the veterinarian, the telephone number of the veterinarian, the type of annual shots and vaccines your pet(s) received and the dates shorts and vaccines were administered. Please provide photocopies of veterinarian certificate(s).
Name of VeterinarianTelephone NumberType of Shot/VaccineDate of Vaccine
×
(1)
IMPORTANT NOTICE: ANYONE WITH A PET IS OBLIGATED TO MEET ANY AND ALL CONDITIONS AS SET FORTH BY THE CITY OF SCARBOROUGH, IN CONJUNCTION WITH BY-LAW 22992. ANYONE WISHING FURTHER INFORMATION ON THE BY-LAW CAN WRITE TO SCARBOROUGH ANIMAL CONTROL, 821 PROGRESS AVENUE, SCARBOROUGH, ON, M1H 2X4 OR CALL THEM AT (416) 396-7387.
Part S: Emergency Contact(s)
Please list your emergency contacts below. In addition, please also list the information of your family physician.
NameAddressTelephoneRelationship
×
(1)
Part T: References
Please provide three (3) references. Do not use family members as references
NameAddressTelephoneRelationship
×
(1)
Part U: Declaration

PLEASE READ AND SIGN THE FOLLOWING DECLARATION FORM.


I/We hereby declare that all statements made in the foregoing application are correct, accurate and complete. I​/We also agree to provide Aldebrain Attendant Care Services of Toronto with any documentation requested, in order to substantiate any statements made within this application.


I/We fully understand that this application and any supporting documents provided, or that may be requested will become the property of Aldebrain Attendant Care Services of Toronto. 


I/We understand that Aldebrain Attendant Care Services of Toronto, or any agent(s) assigned may check the information provided, and may also contact the support agency(ies), or contact any person(s) named in order to verify any information. I/We further understand that the information provided will facilitate a credit check; and I/We hereby consent to a credit check and authorise Aldebrain Attendant Care Services of Toronto to request and obtain any additional information from any of the agency(ies) or party(ies) named in this application. 


I/We further understand that this application does not constitute an agreement on the part of Aldebrain Attendant Care Services of Toronto to provide me/us housing; and I/We further understand that only those individuals who have been identified in part E (Co-applicant(s)); Part F (Children); and Part G (Family Member(s)) can live at Aldebrain Attendant Care Services of Toronto. 


I/We further understand that if, at any time, it comes to the attention of Aldebrain Attendant Care Services of Toronto that any, or all of the information provided was incorrect, inaccurate or incomplete, or has been falsified in any way, that this will be the cause for my/our lease to be terminated. 


I/We fully understand and agree that Aldebrain Attendant Care Services of Toronto is based on the concept of "Neighbour Helping Neighbour" and will conduct myself/ourselves accordingly. 

Applicant
(Sign Here)
Clear Signature
Applicant
(Sign Here)
Clear Signature
ALL INFORMATION IS KEPT STRICTLY CONFIDENTIAL
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