Maine Mortgage Loan Originator MLO Employment Verification Form

Exhibit #2



Name of Applicant for Mortgage Loan Originator (MLO) License________________________

Address of Applicant:________________________________________________________________

Applicant’s NMLS Unique ID Number:  ______________

I, ___________________________________ hereby certify, to the best of my

(Name of employer’s certifying officer)

knowledge, information and belief, that:  ___________________________________

(Name of Applicant)

  • Is a bona fide W-2 employee                     OR o  Is an exclusive agent

(Only select one)           

of:  _________________________________________________________________________________

(Name of Company or Organization)

and is covered under surety bond number _________________________ (copy attached) on file with the Maine Bureau of Consumer Credit Protection.

Furthermore, I certify that the employer:

  • Holds a Maine Supervised Lender or Loan Broker license number:  ___________(Enter Maine license number)
  • Has a pending application for a Maine supervised lender and or loan broker license.

o  Other (explain)

___________________       ____________________           __________________    _____________

Print Name                                  Print Title                             Signature                       Date

STATE OF:  __________________

COUNTY OF:  _____________________, to wit:

Sworn and subscribed before me this _________ day of __________, __________.


Notary Public

My commission expires: ______________________