Request For Verification Of Employment Form

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 prospective 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.

Part I - Request

1. To (Name and address of employer)

2. From (Name and address of lender)

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.

3. Signature of Lender

4. Title

5. Date

6. Lender’s Number

(Optional)

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.

7. Name and Address of Applicant (include employee or badge number)

8. Signature of Applicant

Part II – Verification of Present Employment

9.

Applicant’s Date of Employment

10. Present Position

11. Probability of Continued Employment

12A. Current Gross Base Pay (Enter Amount and Check Period)

13. For Military Personnel Only

14. If Overtime or Bonus is Applicable, Is Its

Continuance Likely?

Pay Grade

Annual

Hourly

Overtime

Yes

No

Monthly

Other (Specify)

Type

Monthly Amount

Bonus

Yes

No

$ _________________

Weekly

Base Pay

$

15. If paid hourly – average hours per week

12B. Gross Earnings

Rations

$

Type

Year To Date

Past Year

Past Year

Flight or Hazard

$

16. Date of applicant’s next pay increase

Thru ___________

Base Pay

Clothing

$

Overtime

Quarters

$

17. Projected amount of next pay increase

Commissions

Pro Pay

$

18. Date of applicant’s last pay increase

Overseas or

Bonus

$

Combat

19. Amount of last pay increase

Variable Housing

Total

$

Allowance

20. Remarks (If employee was off work for any length of time, please indicate time period and reason)

Part III – Verification of Previous Employment

21. Date Hired

23. Salary/Wage at Termination Per (Year) (Month) (Week)

22. Date Terminated

Base _____________ Overtime _____________ Commissions _____________ Bonus _____________

24. Reason for Leaving

25. Position Held

Part IV – Authorized Signature -

Federal statutes provide severe penalties for any fraud, intentional misrepresentation, or criminal connivance

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 the

HUD/CPD Assistant Secretary.

26. Signature of Employer

27. Title (Please print or type)

28. Date

29. Please print or type name signed in Item 26.

30. Phone No.

Fannie Mae

Form 1005

July 96

®

Verification of Employment ~ 08/2013 ~ Encompass360