hancock-mortgage - hancock-mortgage

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Availability Date:

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Branch:*

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Street Address

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Primary Business Contact Number:*

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Home Phone:

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Personality Type: (www.16personalities.com)*

ex. ENTJ-A

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Branch Manager's Name:

Current Production (Originators Only):

Production Goal (Originators Only):

Years in Industry:*

Education/Experience:

Attach Resume' (Please include 3 Professional References):*

Mortgage Originator Licenses

	State:	License #:
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Name as it shows in NMLS:

NMLS ID # (Enter NA if not LO, Originating BM or SM):*

All individuals applying to provide services to City 1st must answer the following questions. If any event or action arises after submitting these declarations which would cause you to answer "Yes" to any question below, you must immediately provide all details in writing to City 1st. If you fail to answer any of the below accurately, this may be grounds for immediate dismissal.

1. Have you ever been convicted of or plead guilty to (including a "plea in abeyance") any misdemeanor or felony in any state?*

YesNo

If yes, provide details about the misdemeanor or felony, including but not limited to conviction, conviction date, penalty and court.

2. Are you on probation or on parole for a conviction?*

YesNo

If yes, provide details including the terms of incarceration and, if applicable, list name, address and phone number of probation officer.

3. Are there any felony or misdemeanor charges (other than minor traffic offenses) pending against you?*

YesNo

If yes, provide details about the pending charges, including but not limited to charge, date and court.

4. Have you ever surrendered, resigned, cancelled or been denied a professional license or other credential in any state?*

YesNo

If yes, provide details, including but not limited to credential and state.

5. Have you ever been the subject of disciplinary action including, but not limited to, civil forfeitures, cease and desist orders, injunctions, license suspensions, denials, revocations, warnings, reprimands, enforcement actions, probation or limitations by any regulatory agency or court?*

YesNo

If yes, provide details about the disciplinary action, including, but not limited to date, regulatory agency or court and type of discipline.

6. Is disciplinary action pending against you in any state? If yes, provide details, including, but not limited to action, regulatory agency or court and state.*

YesNo

If Yes, please explain:

7. Is a suit, claim or other civil action relating to the performance of professional services pending against you in any state?*

YesNo

If yes, provide details, including, but not limited to agency or court and date.

8. Have you ever been licensed/credentialed under any other names(s)?*

YesNo

If yes, list all names.

9. Have you ever worked for City 1st before?*

YesNo

If yes, when and where?

10. Do you know anyone who currently works for City 1st?*

YesNo

If yes, who?

11. Have you filed a personal bankruptcy petition or been the subject of an involuntary bankruptcy petition?*

YesNo

If Yes, please explain:

12. Based upon events that occurred while you exercised control over any organization, have you filed a bankruptcy petition or been the subject of an involuntary bankruptcy petition?*

YesNoNot Applicable

If Yes, please explain:

13. Do you have any unsatisfied judgments or liens against you?*

YesNo

If Yes, please explain:

14. Have you been convicted of, or pleaded no contest to any crime within the past 10 years or have you been held liable in any civil action by final judgment or any administrative judgment by any public agency within the past seven years?*

YesNo

If Yes, please explain:

If you have answered 'Yes' to any Declaration question above and have not explained in the provided space, your application will be considered incomplete and you will not be hired until an explanation has been given in writing to your Branch Manager.

I hereby acknowledge receipt of the Corporate Policy Handbook and agree to all policies contained therein, and as updated and published to 1stLink from time to time. I attest that I have completed City 1st Harassment Training and agree to abide by all policies as explained therein, and that any violation or non-support of any of these policies is grounds for immediate dismissal from City 1st. I also acknowledge that I may not engage in any regulated loan activities unless I possess an active license to do so in the state or jurisdiction of those activities, this irrespective of being hired and/or being issued any systems' passwords by City 1st. I hereby certify that all declaration statements above are true and correct to the best of my knowledge.

Applicant Signature (Type Full Name):*

Date Signed:*

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Employment Application

Personal Contact Information

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Mortgage Originator Licenses

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