Employee Loan Application
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. This is an application that
is to be given to the employee to be filled out and returned to
the appropriate company representative for review.
Who should use this document? Businesses that intend to
offer loans to their employees
ALL INFORMATION AND FORMS ARE PROVIDED “AS IS” WITHOUT ANY WARRANTY,
EXPRESS, IMPLIED, OR OTHERWISE, INCLUDING AS TO THEIR LEGAL EFFECT AND
COMPLETENESS. They are for guidance and should be modified to meet your needs and the
laws of your state. Use at your own risk. Docstoc and anyone who participated in providing or
modifying any form is not creating or entering into an Attorney-Client relationship. Docstoc
does not provide legal advice. The information and forms are not a substitute for the advice of
your own attorney.
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: ______________________________
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.
____ 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:_____________________________________________