Employment Verification Form

Request for Verification of Employment
Request
Name and address of employer
Name and address of lender
Iowa Heartland Habitat for Humanity
803 W 5th St
Waterloo, IA 50702
Title
Date

MonthDayYear
Date
Lender's Number (Optional)
I have applied for a mortgage loan and stated that I am now or was formerly employeed by you. My signature below authorizes verification of this information.
Name and Address of Applicant (include employee or badge number)
Verification of Present Employment
Applicant's Date of Employment

MonthDayYear
Date
Present Position
Probability of Continued Employment
Current Gross Base Pay (Enter Amount and Check Period)
Check Period

AnnualMonthlyWeeklyHourlyOther

Gross Earnings

If Overtime or Bonus is Applicable, is its Continuance Likely?

	Yes	No
Overtime
Bonus

If paid hourly - average hours per week
Date of applicant's next pay increase

MonthDayYear
Date
Projected amount of next pay increase
Date of applicant's last pay increase

MonthDayYear
Date
Amount of last pay increase
Remarks (if employee was off work for any length of time, please indicate time period and reason)
Authorized Signature
Signature of Employer

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Printed Name Signed
Title
Phone No.
Please enter a valid phone number.
Date

MonthDayYear
Date
Should be Empty:

Request for Verification of Employment