This document is an Employee Loan Application to be used by a company that wants to
offer its employees the opportunity to apply for a loan from the company. Companies
should provide this form to employees and the employee should complete the form and
return it to the appropriate company representative for review. This form allows an
employee to repay the loan in installments over a designated number of payroll periods.
EMPLOYEE LOAN APPLICATION
_______________________ [Instruction: insert Company name]
_________________________ [Instruction: insert Company address]
An active full-time employee, who has completed their probationary period and has maintained
uninterrupted employment with _______________________ [Instruction: insert Company
name] (the “Company”) for the preceding _______________________ [Instruction: insert
number of months or years, e.g., “five (5)”] consecutive _______________________
[Instruction: insert either “months” or “years”] and who does not have a currently
outstanding employee loan, may apply for an employee loan in an amount that does not exceed
_______________________ [Instruction: insert percentage, e.g., “10%”] of their base
_______________________ [Instruction: choose either “annual”, “quarterly”, “monthly” or
“weekly”] salary. In no event shall the loan exceed the maximum loan amount of
_______________________ [Instruction: enter the maximum loan amount in dollars, e.g.,
“two thousand and 00/100 ($2,000)”].
The applicable annual interest rate shall be fixed at [Instruction: insert the following language
in quotation marks if the annual interest rate shall be the prime rate or enter custom fixed
annual interest rate: “the prime rate at the time the application is approved” [OR]
_______________________ [enter fixed annual interest rate].
[Note: Choose one of the two options above as to the annual interest rate that will be
applied to the loan. State and federal statutory code and/or legal counsel should be
consulted prior to setting an annual interest rate other than the prime rate to assure that
such annual interest rate does not offend usury laws.]
All applications will be reviewed by the _______________________ [Instruction: identify the
appropriate reviewing party, e.g., “Chief Financial Officer” or “Board of Directors” or
“Finance Committee”]. The review process will include a review of the applicant’s
creditworthiness and a credit report will be obtained in conjunction with each application
submitted. Without exception, an application will be denied if the applicant has outstanding debt
due the Company or has liens or garnishments attaching their wages.
Repayment of the loan and applicable interest shall be made through payroll deductions over a
period not to exceed _______________________ [Instruction: insert number of months or
years, e.g., “five (5) years”].
Personal Information
Name: _____________________________________________
Employee ID Number: _______________________________
Home Address: ______________________________________
Social Security Number: ______________________________
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Birth Date: _________________________________________
Home Phone: _______________________________________
Work Phone No.: ____________________________________
Employment Information
Monthly Salary: _____________________________________
Job Title: __________________________________________
Appointment Status: Full-Time__ Part-Time __
Appointment Percentage: _____________________________
Department Name: ___________________________________
Hire Date: _________________________________________
Supervisor’s Name: __________________________________
Supervisor’s Phone No.: ______________________________
Loan Information
Amount requested: ___________________________________
Requested repayment schedule:
Equal installments over:
____ 1 payroll period
____ 3 payroll periods
____ 6 payroll periods
____ 12 payroll periods
____ [Instruction: insert number of payroll periods] payroll periods
Initial
Here
____ In the event my application is approved, I authorize repayment of this loan via payroll
deduction.
____ I authorize the Company to obtain a credit report concerning my credit history, credit
capacity, credit standing and general creditworthiness.
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____ I acknowledge that additional documentation, including a promissory note, may be
required to process the loan application applied for herein, and I agree to complete such
additional documentation in order to finalize the loan application.
Signature: __________________________________________
Date: _____________________________________________
© Copyright 2013 Docstoc Inc. registered document proprietary, copy not 4
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