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Request for Verification of Employment | ||
Privacy Act Notice: This information is to be used by the agency collecting it or its assignees in determining whether you qualify as a prospective mortgagor under its program. It will not be disclosed outside the agency except as required and permitted by law. You do not have to provide this information, but if you do not your application for approval as a prospec- tive mortgagor or borrower may be delayed or rejected. The information requested in this form is authorized by Title 38, USC, Chapter 37 (if VA); by 12 USC, Section 1701 et. seq. (if HUD/FHA); by 42 USC, Section 1452b (if HUD/CPD); and Title 42 USC, 1471 et. seq., or 7 USC, 1921 et. seq. (if USDA/FmHA). | ||
Instructions: Lender - Complete items 1 through 7. Have applicant complete item 8. Forward directly to employer named in item 1. Employer - Please complete either Part II or Part III as applicable. Complete Part IV and return directly to lender named in item 2. The form is to be transmitted directly to the lender and is not to be transmitted through the applicant or any other party. | ||
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Part I - Request | ||
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1. To (Name and address of employer) Alejandro Rosalez 123 Any Street, Any Town, USA | ||
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2. From (Name and address of lender) Carlos Salazar 100 Main Street, Anytown, USA | ||
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I certify that this verification has been sent directly to the employer and has not passed through the hands of the applicant or any other interested party. | ||
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3. Signature of Lender Carlos Salazar | ||
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[SIGNATURE] | ||
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4. Title Project Manager | ||
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5. Date 12/12/2006 | ||
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6. Lender's Number (Optional) 5555-5555-5555 | ||
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I have applied for a mortgage loan and stated that I am now or was formerly employed by you. My signature below authorizes verification of this information. | ||
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7. Name and Address of Applicant (include employee or badge number) Paulo Santos 123 Any Street, Any Town, USA | ||
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8. Signature of Applicant Paulo Santos | ||
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[SIGNATURE] | ||
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Part II - Verification of Present Employment | ||
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9. Applicant's Date of Employment 06/06/2006 | ||
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10. Present Position General Manager | ||
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11. Probability of Continued Employment 3 years | ||
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12A. Current Gross Base Pay (Enter Amount and Check Period) $ 5600 | ||
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13. For Military Personnel Only | ||
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14. If Overtime or Bonus is Applicable, | ||
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Annual [X] | ||
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Hourly [ ] | ||
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Pay Grade | ||
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10 | ||
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Is Its Continuance Likely? | ||
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Monthly [ ] | ||
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Other (Specify) [ ] | ||
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Type | ||
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Monthly Amount | ||
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Overtime | ||
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Yes [X] | ||
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No [ ] | ||
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Weekly [ ] | ||
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Bonus | ||
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Yes [ ] | ||
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No [X] | ||
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Base Pay $ 520 | ||
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15. If paid hourly - average hours per week 40 hours | ||
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12B. Gross Earnings | ||
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Type | ||
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Year To Date | ||
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Past Year | ||
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Past Year | ||
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Rations $ 162 | ||
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Base Pay | ||
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$ | ||
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Thru 2006 | ||
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15.00 | ||
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$ 20.00 | ||
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$ | ||
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30.00 | ||
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Flight or Hazard $ 756 | ||
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16. Date of applicant's next pay increase 08/08/2007 | ||
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Clothing $ 452 | ||
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Overtime | ||
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$ | ||
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15.00 | ||
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$ 20.00 | ||
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$ | ||
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30.00 | ||
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17. Projected amount of next pay increase $ 5600 | ||
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Quarters $ 986 | ||
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Commissions | ||
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$ | ||
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20.00 | ||
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$ 20.00 | ||
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$ | ||
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15.00 | ||
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Pro Pay $ 123 | ||
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18. Date of applicant's last pay increase 09/08/2006 | ||
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Overseas or Combat $ 645 | ||
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Bonus | ||
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$ | ||
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20.00 | ||
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$ | ||
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20.00 | ||
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$ | ||
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15.00 | ||
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19. Amount of last pay increase $ 4800 | ||
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Total | ||
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$ 70.00 | ||
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$ 80.00 | ||
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$ | ||
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90.00 | ||
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Variable Housing Allowance $ 587 | ||
20. Remarks (If employee was off work for any length of time, please indicate time period and reason) Not Applicable | ||
Part III - Verification of Previous Employment | ||
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21. Date Hired 04/04/2004 | ||
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23. Salary/Wage at Termination Per (Year) (Month) (Week) | ||
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22. Date Terminated 01/03/2005 | ||
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Base $ 9500 | ||
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Overtime 1250 | ||
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Commissions 4500 | ||
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Bonus 4000 | ||
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24. Reason for Leaving Medical Issue | ||
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25. Position Held Device Operator | ||
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Part IV - Authorized Signature - Federal statutes provide severe penalties for any fraud, intentional misrepresentation, or criminal connivance | ||
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or conspiracy purposed to influence the issuance of any guaranty or insurance by the VA Secretary, the U.S.D.A., FmHA/FHA Commissioner, or | ||
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the HUD/CPD Assistant Secretary. | ||
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26. Signature of Employer Richard Roe | ||
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[SIGNATURE] | ||
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27. Title (Please print or type) VA Secretary | ||
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28. Date 01/05/2007 | ||
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29. Print or type name signed in Item 26 Richard Roe | ||
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30. Phone No. 555-0100 | ||
Form 1005 July 96 |
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