Employment Application

This institution does not unlawfully discriminate in any employment practice on the basis of race, color, age, religion, national origin, sex, veteran status or disability. No question on this application is intended to secure information which could be of a discriminatory nature. The use of this form does not indicate that there are any positions open and does not obligate the Bank in any way.

APPLICANT INFORMATION

First Name

Middle Initial

Last Name

Present Address

City

State

Zip Code

Email Address
Home Phone	Work Phone
Are you at least 18 yes of age? Yes No	May we contact you at your present employer? Yes No
Position Applying for	Salary Desired
Referred by	Date Available for Work
Are You Available to Work: (Check all that apply.) Full Time Part-Time Temporary Shift Work
Will you work overtime if required?	Yes No
Are you eligible to work in the United States?	Yes No
Have you been bonded?	Yes No
Have you ever applied here before?	Yes No If Yes, which location?
Have you been employed here previously?	Yes No If Yes, give dates If Yes, which Location?
Do you have a relative who works here?	Yes No
Were (are) you in the U.S. Armed Forces, Reserve status and Reserve Branch?	Yes No If Yes, w hich branch? Date for active duty and highest rank attained?

EMPLOYMENT HISTORY

Company Name	Phone
Address	Employed from (Mo/Yr) to (Mo/Yr)
Name of Supervisor/Title	Starting Hourly Rate/Salary Final
Your title/job duties	Reason for leaving
Brief description of duties and include number of person supervised if applicable.

Company Name	Phone
Address	Employed from (Mo/Yr) to (Mo/Yr)
Name of Supervisor/Title	Starting Hourly Rate/Salary Final
Your title/job duties	Reason for leaving
Brief description of duties and include number of person supervised if applicable.

Company Name	Phone
Address	Employed from (Mo/Yr) to (Mo/Yr)
Name of Supervisor/Title	Starting Hourly Rate/Salary Final
Your title/job duties	Reason for leaving
Brief description of duties and include number of person supervised if applicable.

EDUCATION

High School Name	Address
Course of Study	Did you Graduate? Yes No Diploma or Degree
College Name	Address
Course of Study	Did you Graduate? Yes No Diploma or Degree
Other Educational Institution	Address
Course of Study	Did you Graduate? Yes No Diploma or Degree
List any scholastic honors, offices held, and activities in High School:	List any scholastic honors, offices held, and activities in College:

Optional: Are there any special skills you would like to include that you feel might better qualify you for the job. (You may wish to include civic and community activities, professional societies or special training such as typing, accounting, etc.) Do not include information which would reveal sex, race, color, age, national origin, religion, veteran status or disability.

Please select the level of fluency with foreign languages, if any?

Language speak read write

APPLICANT’S STATEMENT (Applicant must review and sign below.)

I certify that answers given herein are true and complete to the best of my knowledge. I authorize the Bank to investigate all statements in this application and to secure any necessary information from all my employers, references and academic institutions. I authorize the Bank to investigate my background and as a result I will be requested to complete an Authorization to Obtain Consumer and Investigative Consumer Report form. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my background check, MVR, academic credentials, and employment references. I further understand that any false information, misleading statements or omission of facts will be sufficient cause for rejection of my application if the Bank has not employed me and for immediate dismissal if the Bank has employed me.

In the event of my employment with the Bank, I will comply with all rules, regulations, and policies set forth in the Bank's policy manual or other communications distributed by the Bank. Further, I understand that I must immediately notify the Bank if I am convicted of, receive deferred adjudication in, or otherwise plead guilty or no contest to any criminal offense, while my application is pending or during my tenure as an employee.

I understand that nothing in this employment application, in the Bank's policy statements or personnel guidelines, or in my communications with any Bank official is intended to create an employment contract between the Bank and me or for providing any benefit. I also understand that the Bank has the right to modify any of its policies at any time without giving notice of the changes to me. No promises of employment have been made to me. I acknowledge that in the event of my employment, it is for no definite period of time, and may regardless of the date of payment of my salary, be terminated at any time with the customary notice as prescribed by law either by myself or by the Bank without necessity on the part of either for showing special cause for termination based on employment-at-will doctrine.

I hereby acknowledge that I have read and understand the preceding statements.

Date