REGISTER NOW AS A CAIRNS HOMESHARE HOUSEMATE

Details

Your Details

Spouse/Partners Details if applicable

First Name & Family Name

MOBILE:

EMAIL:

Marital Status (drop down)

Single/Married/Defacto

Single/Married/Defacto

Employment Status (drop down)

Employed

Unemployed

Looking for work

Retired

Employed

Unemployed

Looking for work

Retired

Occupation (Eike is there a standard drop down box of jobs you can use?)

Gender (drop down)

Male/Female

Male/Female

Date of Birth

(calendar)

(calendar)

Do you have a criminal record?

YES        NO

When would you be available for a face to face interview in Cairns?

Calendar

Or

Phone interview preferred as not in Cairns yet

I am travelling

Solo

With pets

With a friend

With a partner/husband

With children:  How many:  (choose no)

Comments:

Check In Date

(calendar)

Check Out Date

(calendar)

Type of room required

Single

Twin (2 single beds)

Double (large double bed)

Maximum Budget (can this drop in the rates based on the room type they selected?)

Single (including electricity, water and internet & air con depending on property)

$100.00 - $130.00 per week

$130.00 - $160.00 per week

$160.00 - $190.00 per week

$200.00+ per week

Double/Twin (including electricity, water, and internet/air con depending on property)

$160.00 - $190.00 per week for 2 persons

$190.00 - $220.00 per week for 2 persons

$220.00 - $250.00 per week for 2 persons

$250.00 - $300.00 per week for 2 persons

$300.00 + per week for 2 persons

Would you need a furnished room or do you have your own furniture?

Furnished

Unfurnished

Please select

Preferred location

Cairns City (Less than a 5 minute drive to city centre)

Less than a-10 minute drive to city centre

Less than a 20 minute drive to city centre

20 minutes or more drive to city centre

Preferred gender to share with

Male Female I don’t mind

Housemates ages

I From __(no)___ to __(no)____ years old preferred.

Smoking

Do you smoke? YES NO

Alcohol in the home

 Do you drink socially?   YES    NO

Please choose 6 hobbies/sports from the list below to give a homeowner a good idea of your interests.

Hobbies/sports that I enjoy include (choose max 6):

Sport Watching television

Relaxing at home Gym/Health/Fitness

Movies Outdoor recreation

Weekends away Arts & Culture

Business Internet

Current Affairs Dancing

Fashion People

Travel Nightclubs

Pubs/bars Cooking & food

Wine Music

Reading Studying

Computer games

Other: _________________________________-

Is there any information you wish to share about yourself a potential housemate might need to know E.g religion preference, dietary restrictions, other languages spoken etc.