2007 Agent Multiple Employment Agreement Form printable pdf download

2007 Agent Multiple Employment Agreement Form

S.A. 16 (7/07)

AGENT MULTIPLE EMPLOYMENT

AGREEMENT

_________________________________________________________

(Print/Type Agent’s name and CRD Number)

Pursuant to the requirements of 21 VAC 5-20-95 of the Virginia Administrative Code, an

agent may be employed by more than one registered broker-dealer. In order to comply

with the provisions of the regulation, each broker-dealer identified below consents to the

multiple employment of the agent and agrees to be responsible for the employment

activity of the agent on behalf of each undersigned broker-dealer.

__________________________________

Broker-Dealer Name/CRD# (Type/Print)

By: _____________________________

Signature

__________________________________

Name of Signer (Type/Print)

_________________________________

Title of Signer (Type/Print)

__________________________________

Date

__________________________________

Broker-Dealer Name/CRD# (Type/Print)

By: _____________________________

Signature

__________________________________

Name of Signer (Type/Print)

_________________________________

Title of Signer (Type/Print)

__________________________________

Date

2007 Agent Multiple Employment Agreement Form