1) The document is a home search application form completed by John Walter Gutierrez. He provides personal details like his name, date of birth, address, contact information, gender, and religion. 2) He indicates he is currently employed and lists his wife and son who will be moving with him. 3) For his present accommodation, he selects that he lives in a detached house. 4) In his house preferences, he describes wanting a 3 bedroom, 2 bathroom house with gas, water, and other utilities in a suburban location priced between $350,000-$500,000.

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 applicant’s 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´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´s signature
Name
Date
back yard, garage.
John Walter Gutierrez
07-04-2015
John Walter Gutierrez