
 
2601 N Lamar Blvd    Phone: 512-936-7605 
Austin TX 78705            Fax: 512-936-7610 
occc.texas.gov 
EMPLOYMENT  VERIFICATION  FORM
 
To be completed by the mortgage loan originator's employer 
MLO's NMLS Unique ID Number : 
MLO Applicant's Full Legal Name:  
__________
 
I,  
________________________________ hereby 
certify to the best of my
 
(Name of certifying officer) 
knowledge, information  , and belief, that: 
___________ 
(Name of applicant)
 
 Is a bona fide W-2 employee 
 Is an exclusive agent 
Of
OR 
(Select only one) 
(Legal name of company or organization) 
(Company or organization Address as on file with OCCC) 
Company or Organization  
OCCC License/Registration #:
Furthermore, I certify that the employer: 
Holds a Texas Regulated Loan License
 
Has a pending application for a Texas Regulated Loan License 
Holds a Texas Property Tax Loan License 
Has a pending application for a Texas Property Tax Loan
 License 
Is registered under Chapter 347 of the Texas Finance Code for manufactured  home credit
 transactions 
Has filed for Chapter 347 registration, but has not received a registration receipt 
The undersigned affirms that all answers on the Employment  Verification Form are tru
e and complete. 
Signature 
Date 
Print Name 
Tit le
 
ADM 98 
 
______________________________________________________________________
_______________________________