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Appraisal Application for Service
APPRAISER INFORMATION

* indicates required field

Referred By		   Recruited by SettlementOne

*Appraiser Name
Date

Appraisal Firm Name

Address
County

City
State
Zip

Office Phone
Fax

Cell Phone
Email
  OR
Social Security Number
Tax Id Number
Please Specify:          Self-Employed      Owner/Officer      Partner      Employee 

Number of Firm Appraisers
Years Appraising Experience

Maximum Open Order Capacity   (Maintaining ability to meet due dates)


STATE LICENSING & CERTIFICATION INFORMATION     (Attach copies of all licenses)

State Licensed Certified License or Certification Number Expiration Date


ADDITIONAL INFORMATION

Are you set up for EDI transmission?   Yes     No Appraisal Software: 
Are you approved for HUD/FHA work?   Yes     No Appraisal Software: 
Specialized Experience:   REO    Relocation    Review # Completed in Last Year: 


APPRAISAL COVERAGE     (List specific counties/states - If you don't cover the entire county, then specify the cities/towns and zip codes)

State
Counties
 


DISCIPLINARY ACTIONS

Have you ever been the subject of a lawsuit by a lender or investor?   Yes     No
If yes, please explain:
Have you ever been disciplined by a state appraisal licensing agency?   Yes     No
If yes, please explain:
Have you ever had a claim filed against your Errors & Omissions Insurance:   Yes     No
If yes, please explain:

MINORITY OR WOMEN-OWNED BUSINESS

SettlementOne may provide appraisals to the U.S. Department of Housing and Urban Development (HUD) under terms and conditions contained in service agreements with some of our clientele. These agreements stipulate that those clients shall comply with all applicable laws, regulations and directions pertaining to subcontracting with small business concerns owned and controlled by socially and economically disadvantaged individuals. In order to maintain our files and to provide reports required by HUD and/or other governmental agencies, please complete this section of the Appraiser Application Form. Please check the appropriate boxes:
  African American
  Native Americans (including American Indians, American Eskimos, American Aleuts & Native Hawaiians)
  Hispanic Americans (from any Latin American country in South America, Central America or the Caribbean)
  Asian-Pacific Americans (from Japan, China, Okinawa, Philippines, Vietnam, Korea, Samoa, Guam, Northern Marinas, Laos, Cambodia, Thailand, Taiwan & the U.S. Trust Territories of the Pacific)

  Asian-Indian Americans (from India, Pakistan and Bangladesh)

  Women-Owned Business Concern: a concern that is at least 51% owned or is a publicly-owned business where the combined total of all classes of stock is owned by a woman or women who are U.S. citizens and who also control and operate the business. "Control" in this context shall mean exercising power to make policy decisions and "operate" shall mean being actively involved in the daily management of the business.

The signer represents that their enterprise: IS   IS NOT a minority or women-owned business.

SettlementOne is fully committed to the policies and guidelines of the Community Reinvestment Act, the Federal Fair Housing Act, the Equal Credit Opportunity Act and adheres to Non-Discrimination practices in the appraisal process. Federal regulations prohibit discrimination in the selling, brokering or appraising of residential real property. SettlementOne does not support or encourage discrimination or any like practices of any form. I understand that omission or misrepresentation of material fact in this application may result in the refusal of consultant services. I acknowledge that SettlementOne, at their sole discretion and for any reason, has the option of not accepting my application or changing my status at any time. I hereby authorize SettlementOne to make any investigation of my background deemed necessary and to release copies of my application package (resume or license) to their clients upon request.



LIABILITY/WORKERS COMPENSATION INSURANCE INFORMATION

An Appraiser is not an employee or an agent of SettlementOne for any purpose. An Appraiser is an independent contractor and is not eligible to participate in or receive any benefit from any company benefit plan, program or other arrangement that may, from time-to-time, be available to employees of SettlementOne including but not limited to any health, disability or life insurance, vacation, holiday or sick leave pay or profit sharing/pension plans. SettlementOne will NOT provide workers' compensation for any Appraiser. FOR STATES OF OHIO, NORTH DAKOTA, WASHINGTON, WEST VIRGINIA and WYOMING, an Appraiser has the affirmative obligation under this "Agreement" to furnish proof to SettlementOne, that at all times, it has an active policy of Workers' Compensation Insurance in the state/s in which the Appraiser does business. For all States, any Appraisal Firms which have employees, the Appraisal Firm has the affirmative obligation under this "Agreement" to furnish proof to SettlementOne, that at all times, it has an active policy of Workers' Compensation Insurance in the state/s in which the Appraisal Firm does business. An Appraiser or Appraisal Firm is solely responsible for payment of applicable taxes and withholdings, respecting all payments made under this "Agreement", and for all claims, damages and/or lawsuits arising out of the acts of an Appraiser and/or an Appraisal Firms' employees, subcontractors and agents.

Contracts for appraisal assignments are given on a job-to-job basis. SettlementOne has the sole discretion as to whom appraisal assignments will be offered. SettlementOne does not guarantee employment as an independent contractor or offer a guaranteed amount of compensation.

By signing this "Agreement", an Appraiser or Appraisal Firm agrees to maintain adequate Errors & Omissions insurance, automobile insurance and a policy for Workers' Compensation Insurance (when applicable) for the Appraiser, Appraiser's employees, Appraiser's subcontractors and Appraiser's agents. The Appraiser or Appraisal Firm further agrees to furnish SettlementOne with a copy of the Errors & Omissions insurance certificate and Workers' Compensation insurance certificate in all states in which they do business. I, as the Appraiser or designated representative of an Appraisal Firm, acknowledge that this is a condition which is precedent to doing business with SettlementOne.

Appraisar Signature
Date Signed


APPRAISAR SERVICE AGREEMENT

  I have read and agree to the Appraiser Service Agreement Requirements

NON-SOLICITATION & NON-DISCLOSURE

  I have read and agree to the Non-Disclosure Agreement

Company
Date Signed

Signature
Title

Name Printed