Welcome To American Nationwide Mortgage


1. Personal Information

Last Name
First Name
Middle Initial
Date of Birth (Month-Day-Year)
Home Phone Number (000-000-0000)
Day Time Phone
Cell Number
Pager Number
Fax Number
E-Mail Address
Street Address (Must be a street address)
City
State
Zip
How did you hear about ANMC?
Average Loans per month
Number of funded loans last month
Number of funded loans YTD
Average Loan Amount?
Volume of Loans Closed in the Past 12/24 Months
How many Loan Officers do you currently have?
How many Loan Officers do you plan to have in 90 days?
Please list all states in which you are doing business

2. Origination Experience

Number of years as a Loan Officer
Processor
Branch Manager
Do you have VA/FHA Experience?
Will you be doing FHA business?
Have you defaulted on any type of government loan (i.e. mortgage, student, etc)?

3. Employment Information

Current Employer
Company Name
Street Address
City
State
Zip
May We Contact Them	Yes No
Phone Number
Number of Years


Previous Employer
Company Name
Street Address
City
State
Zip
May we contact them	Yes No
Phone number
Number of years

4. Genral Information

Has a lender ever suspended you?	Yes No
Has a State Regulatory Agency ever suspended you?	Yes No
Have you ever had a license revoked or suspended?	Yes No
Is there any pending litigation against you?	Yes No
Has your license ever been revoked, suspended or have you ever had any disciplinary action from any regulatory agency?	Yes No
Are you the subject to any complaint, proceeding or investigation by a regulatory agency?	Yes No
Have you, your company or any principals or agents ever been suspended by a Lender?	Yes No
Have you or any of your Loan Officers ever been convicted of a felony or misdemeanor?	Yes No

The completion of this employment application certifies that all the information furnished in this application is true and correct and that I have not misrepresented or withheld any information. I understand that the falsification of this information may result in immediate dismissal. I further acknowledge that any employment offered to me or which I accept is employment at will and may be terminated by me or the company at any time with or without reason. I understand that any offer of employment may be contingent upon a background investigation, which may include criminal, motor vehicle and/or previous employment. I hereby authorize all references and former employers listed on my application to give the company any and all information concerning my previous employment and any pertinent information they might have, personal or otherwise, and release all parties from any claims, causes of action, or liability from damages that may or could result from furnishing such information to the company. I understand that I will not or cause any borrower of American Nationwide Mortgage Company to be solicited within 1 year period of loan closing.


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American Nationwide Mortgage Company, Inc