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Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.
A1 Level 1 : Learning activity 3 : Stage 1A1 Level 1 : Learning activity 3 : Stage 3
MOVING TO A NEW PLACE
Home earch application orm
Please write the first or main applicants surname here
Important: Please make sure you read all the information presented in this document carefully before
you complete this form.
First name(s)
Give any other name(s)
you were previously known by
Date of birth
For example 06/12/1968
Current address
Postcode
Contact/correspondence
or safe address (if different
from above)
Contact telephone
numbers(s)
Email address
A.	 Your details
Gutierrez
John
Walter
10/08/1971
16 Street 17-05
051020
3103246938
jwaltergc@hotmail.com
Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.
A1 Level 1 : Learning activity 3 : Stage 1
Do you experience difficulties
with reading or writing?
What卒s your gender?
What is your religion?
Yes
Yes
Male
Prefer not to say
Muslim Sikh
Buddhist
Christian
None
Hindu
Jewish
Other
(please specify)
No
No
Female
B.	 Employment information
C.	 Your family or household
If you are working, please tell us:
What do you do?
We need to know if other people will be moving with you. This will help us to know what type of home
you will need. Please give their details below.
1st 2nd 3rd
Last name
First name
Date of birth
Gender
Relationship
to you (wife,
son, etc.)
X
X
X
X
Employee
Cordoba Gutierrez
Rosa Daniel
1/01/1970 25/07/1992
F M
Wife Son
Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.
A1 Level 1 : Learning activity 3 : Stage 1
D.	 Your present accommodation/circumstances
E.	 Your house preferences
Tick the box against the property type in which you live or best describes your circumstances.
State your house preferences describing all the characteristics you want your new home to have.
House Trailer Hostal
Flat/apartment condominium Hotel
Bungalow Cottage Terraced house
Detached house Semi-detached house No fixed address
House type (apartment, cottage, etc.)
Number of rooms
Number of bathrooms
Which floor (if located in a building)
Public utilities (gas, water, etc.)
Location
Price
X
House
3
2
Gas, power, water, phone line, internet.
Suburban
$350.000- $500.000
Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.
A1 Level 1 : Learning activity 3 : Stage 1
F.	 Special requirements
Write a more detailed description of the kind of house you want to have.
G.	 Applicant卒s signature
Name
Date
back yard, garage.
John Walter Gutierrez
07-04-2015
John Walter Gutierrez

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  • 1. Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013. A1 Level 1 : Learning activity 3 : Stage 1A1 Level 1 : Learning activity 3 : Stage 3 MOVING TO A NEW PLACE Home earch application orm Please write the first or main applicants surname here Important: Please make sure you read all the information presented in this document carefully before you complete this form. First name(s) Give any other name(s) you were previously known by Date of birth For example 06/12/1968 Current address Postcode Contact/correspondence or safe address (if different from above) Contact telephone numbers(s) Email address A. Your details Gutierrez John Walter 10/08/1971 16 Street 17-05 051020 3103246938 jwaltergc@hotmail.com
  • 2. Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013. A1 Level 1 : Learning activity 3 : Stage 1 Do you experience difficulties with reading or writing? What卒s your gender? What is your religion? Yes Yes Male Prefer not to say Muslim Sikh Buddhist Christian None Hindu Jewish Other (please specify) No No Female B. Employment information C. Your family or household If you are working, please tell us: What do you do? We need to know if other people will be moving with you. This will help us to know what type of home you will need. Please give their details below. 1st 2nd 3rd Last name First name Date of birth Gender Relationship to you (wife, son, etc.) X X X X Employee Cordoba Gutierrez Rosa Daniel 1/01/1970 25/07/1992 F M Wife Son
  • 3. Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013. A1 Level 1 : Learning activity 3 : Stage 1 D. Your present accommodation/circumstances E. Your house preferences Tick the box against the property type in which you live or best describes your circumstances. State your house preferences describing all the characteristics you want your new home to have. House Trailer Hostal Flat/apartment condominium Hotel Bungalow Cottage Terraced house Detached house Semi-detached house No fixed address House type (apartment, cottage, etc.) Number of rooms Number of bathrooms Which floor (if located in a building) Public utilities (gas, water, etc.) Location Price X House 3 2 Gas, power, water, phone line, internet. Suburban $350.000- $500.000
  • 4. Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013. A1 Level 1 : Learning activity 3 : Stage 1 F. Special requirements Write a more detailed description of the kind of house you want to have. G. Applicant卒s signature Name Date back yard, garage. John Walter Gutierrez 07-04-2015 John Walter Gutierrez