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?
Annual Hourly Pay Grade
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 $
Overseas or 18. Date of applicant’s last pay increase
Bonus $
Combat
Variable Housing 19. Amount of last pay increase
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®
