Employee Hardship Loan Application

The Hardship Program provides eligible employees with a loan of up to $750, which is repaid with interest over 13 pay periods. Please review the full Hardship Program policy on DocTract on the Intranet (Policy 4.10.005). Eligibility Requirements: To qualify for a Hardship Loan, an employee must be experiencing an unexpected family emergency, such as a medical crisis or a sudden loss of transportation, housing, or utilities. Employees must also meet the following criteria: 1) Be employed full time or part time 2) Have at least 180 days of continuous employment 3) Have no corrective actions within the 180 days prior to applying 4) Have no more than one active hardship loan at a time

Job Status
I have read and understand the policy for the Employee Hardship Loan.(Required)
I certify that all information contained in this application is true, correct and falsification of information may result in denial and/or corrective action.(Required)
I understand that to obtain a loan under the Employee Hardship Loan Policy, I must remain in good standing from the time of application until repayment of the loan.(Required)
I understand there is a repayment requirement and the Employee Hardship Loan Contract that will be signed by me when I receive my loan check.(Required)
I understand that if I leave Cheyenne Regional employment prior to the end of my repayment period, I will repay Cheyenne Regional the remaining balance of my Employee Hardship Loan from my final paycheck. If there are not sufficient funds to pay my remaining balance, I agree that I will be billed for the balance owed.(Required)
I understand that Cheyenne Regional reserves the right to amend or terminate the offering of the Employee Hardship Loan, at any time.(Required)
I understand there is a repayment requirement and that I will be required to sign the Employee Hardship Loan Contract.(Required)
I understand that this is not a contract of employment, and that all employment with Cheyenne Regional is voluntary and at-will, meaning that I or Cheyenne Regional have the right to terminate the employment relationship at any time, for any reason or no reason, and that this agreement does not alter that at-will employment relationship.(Required)
I understand that if I leave Cheyenne Regional employment prior to the end of my repayment period, I will repay Cheyenne Regional the remaining balance of my Employee Hardship Loan from my final paycheck. If there are not sufficient funds to pay my remaining balance, I agree that I will be billed for the balance owed.(Required)
I understand that Cheyenne Regional reserves the right to amend or terminate the offering of the Employee Hardship Loan, at any time.(Required)
I am in good standing and not on corrective action.(Required)
I do not currently have an Employee Hardship Loan.(Required)

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