Middlestead Mortgage Employment Application

• Fixed Rate Mortgages
• ARMs
• Home Equity Loans
• Purchasing & Refinancing Loans
• New Construction Loans
• Manufactured Housing Loans
• Less Than Perfect Credit Loans
• Interest Only Loans
• No Closing Cost Loans
• WHEDA, FHA, and VA Loans
• Title Insurance with ABC Title

©2008 Middlestead Mortgage, LLC
All Rights Reserved
3215 W. College Avenue
Appleton, WI 54914
920-731-9590
Toll-Free: 866-731-9590

Equal Opportunity Employer

Personal Information

Last Name
First Name
Address
City		State	Zip
Email	Phone		Cell

Position Applied For			Salary
Type of Employment Desired Full-Time Part-Time Summer
Days of the Week Desired M T W Th F Wnd
Work Hours Days Mornings Afternoons
Have You Ever Applied for Employment With Us Before? Yes No
Are You 18 Years or Older? Yes No
Are You a US Citizen? Yes No

Educational Background

Name and Location	Years Attended	Did You Graduate?	Degree or Course of Study
Graduate School
College
Business/Technical
High School

Employment History

Employer		Job Title
From: (Month, Day, Year)		To: (Month, Day, Year)
Address	Phone	Reason For Leaving
Supervisor		May We Contact the Employer? Yes No
Please Check One: Full-Time Part-Time Temp
HourlyRate/Salary:
Start $	Per Hour Annual	Final $	Per Hour Annual

Employer		Job Title
From: (Month, Day, Year)		To: (Month, Day, Year)
Address	Phone	Reason For Leaving
Supervisor		May We Contact the Employer? Yes No
Please Check One: Full-Time Part-Time Temp
HourlyRate/Salary:
Start $	Per Hour Annual	Final $	Per Hour Annual

Skills and Qualifications

Please summarize special skills and aptitudes acquired from employment experiences that you feel qualify you for a position with Middlestead Mortgage.

Authorization

IMPORTANT
Please read carefully. By submitting this form you agree to the following:

It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and or separation from Middlestead Mortage if I have been employed. Furthermore, I understand that just as I am free to resign at any time, Middlestead Mortgage reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of Middlestead Mortgage has the authority to make any assurances to the contrary.

I give Middlestead Mortgage the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability, Middlestead Mortgage and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information. If Middlestead Mortgage decides to engage an investigative consumer reporting agency to report on my credit and personal history, I hereby give authorization to do so. If a report is obtained, Middlestead Mortgage must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.