$ $ Current Outstanding Monthly Due Monthly Payment Balance Date Lender/Servicer: Account Number: and Year loan repayment started/will start: $ $ Current Outstanding Monthly Due Monthly Payment Balance Date Lender/Servicer: Account Number: Month and Year loan repayment started/will start: $ $ Current Outstanding Monthly Due Monthly Payment Balance Date $ TOTAL Outstanding Balance: TOTAL Monthly Payment: $ Oklahoma JRJ Loan Repayment Program 2017 2018 – Employment Verification Section A - Release (to be completed by applicant) Last Name: First Name: MI: Address: City: State: Zip Code: I authorize my employer to provide the employment information requested by the Oklahoma JRJ Loan Repayment Program. _________________________________________________ _____________________________ Applicant's Signature Date ******************************************************************************************************************** Section B - Employment (to be completed by employer) The above named employee has applied for benefits from Oklahoma JRJ Loan Repayment Program. Please complete the following section and return this form to the applicant. Job of Employee: Date of Hire: Is the applicant employed full-time (not less than 75 percent of a 40 hour work week?) Yes No
$ $ Current Outstanding Balance Monthly Due Date Monthly Payment Lender/Servicer: Account Number: and Year loan repayment started/will start: $ $ Current Outstanding Balance Monthly Due Date Monthly Payment Lender/Servicer: Account Number: Month and Year loan repayment started/will start: $ $ Current Outstanding Balance Monthly Due Date Monthly Payment TOTAL Outstanding Balance: $ TOTAL Monthly Payment: $ Oklahoma JRJ Loan Repayment Program 2017 – 2018 Employment Verification Section A - Release (to be completed by applicant) Last Name: First Name: MI: Address: City: State: Zip Code: I authorize my employer to provide the employment information requested by the Oklahoma JRJ Loan Repayment Program. _________________________________________________ _____________________________ Applicant's Signature Date ******************************************************************************************************************** Section B - Employment (to be completed by employer) The above named employee has applied for benefits from Oklahoma JRJ Loan Repayment Program. Please complete the following section and return this form to the applicant. Job of Employee: Date of Hire: Is the applicant employed full-time (not less than 75 percent of a 40 hour work week?) Yes No
2017-18%20JRJ%20Application%20-%20New%20Applicants%20(Updated%2011.15.17).docx