EMPLOYMENT

List your last 2 years of employment

EMPLOYER

DATES

FROM Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec TO Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

FROM Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec TO Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

FROM Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec TO Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

FROM Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec TO Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

FROM Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec TO Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

List reason(s) and duration of any employment gaps over the past 2 years.

Do you work Full Time or Part Time?

Are you self employed? ... Yes No

INCOME

Gross monthly income Pay type ... Hourly Salary Pay Interval ... weekly bi-weekly monthly

Do you work overtime? ... Yes No Average monthly amount

Bonus income? ... Yes No Average monthly amount:
Details (if any):

Do you have a 2 year history of overtime and/or bonus income? ... Yes No

Other income? (briefly explain)
 

CREDIT

My credit history is:  Excellent
                                          Good, but some lates
                                          Some credit problems
                                          Major credit problems
                                          Don't know

Have you filed for bankruptcy within the past 2 years? ... Yes No

Briefly explain any unique credit situations:
 

LIABILITIES AND ASSETS

Total all monthly payments (credit cards, loans etc.):

Total available assets to purchase a home:

CONTACT INFORMATION

First Name   Last Name

Address   Apt #

City      State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY       Zip

Home Phone

Work Phone Ext.

Email