EMPLOYMENT APPLICATION

"*" indicates required fields

Step 1 of 7 - Personal Info

14%

* Required

Equal access to programs, services and employment is available to all persons. Those applicants requiring a reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department. We are an equal opportunity employer.

Position Applied For*

Date of Application*

Month

Day

Year

Name*

First Middle Last

Have you worked under any previous names? If so, please list the name below.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Expected Pay and Start Date

Expected Pay

Start Date

Month

Day

Year

Do you prefer full time or part time?*

Full Time

Part Time

How were you referred to our company?*

Have you submitted an application here before?*

Yes

Please give date(s) and positions(s) previously applied for:*

Have you ever been employed here or at another financial institution?*

Yes

Please list financial institution(s) where you have been employed and give dates:*

Are you legally eligible for employment in the United States? (If yes, proof is required when hired.)*

Yes

Are you able to perform the “essential functions” of the job for which you are applying (with or without reasonable accommodation)?*

NOTE: This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage, or the extent permitted by law.

Yes

Need more information about the job’s “essential functions” to respond

Would you need to request any time off over the first 90 days of employment?*

Yes

Please provide date(s):*

Have you ever been required to post bond?*

Yes

Have you ever been convicted of a felony?*

NOTE: Answering “yes” to the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Yes

If yes, please explain:*

If driving is required for this job, please provide your driver’s license number and state issued.

License or ID Number

State Issued

Have you entered into an employment agreement with any former employer or other party that may contain a non-competition agreement?*

Yes

If yes, please provide date(s) and details:*

Employment History

Please provide some information about your 3 most recent employers, starting with your current or most recent employer.

Current Employer and Contact*

Supervisor Name*

Supervisor Email

Employer Address*

Street Address Address Line 2 City State ZIP Code

May we contact this Employer?*

Yes

Your Job Title*

Job Duties

Dates Employed*

Pay*

Reason for Leaving*

What did you like most about this position?*

What were the things you liked least about this position?*

Employer 2

Employer and Contact*

Supervisor Name*

Supervisor Email

Employer Address*

Street Address Address Line 2 City State ZIP Code

Your Job Title*

Job Duties

Dates Employed*

Pay*

Reason for Leaving*

What did you like most about this position?*

What were the things you liked least about this position?*

Employer 3

Employer and Contact*

Supervisor Name*

Supervisor Email

Employer Address*

Street Address Address Line 2 City State ZIP Code

Your Job Title*

Job Duties

Dates Employed*

Pay*

Reason for Leaving*

What did you like most about this position?*

What were the things you liked least about this position?*

Have you ever been fired or asked to resign from a job?

Yes

High School*

Course of Study*

Did you graduate?*

Yes

Degree or diploma*

College*

Special Training or Skills

Reference 1

Reference Name*

Relationship*

Contact Information*

Reference 2

Reference Name*

Relationship*

Contact Information*

Reference 3

Reference Name*

Relationship*

Contact Information*

Applicant Waiver

I certify that the information provided on this application is correct to the best of my knowledge and understand that falsification of this information or omissions or misrepresentations are grounds for refusal to hire or, if hired, my employment may be terminated. If hired, I agree to conform to the Credit Union’s rules and regulations, and I understand that these rules, including the employee handbook procedures and processes, do not form a contract of employment either express or implied. I agree that my employment with the Credit Union and any compensation can be terminated, with or without cause and with or without notice, at any time, by myself or the Credit Union. I hereby authorize any of the persons, educational institutions, or organizations listed in my application to provide all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and release all such parties from all liability that may result from furnishing such information to the credit union. I authorize the credit union, its representatives, employees, or agents to request and receive employment or criminal information on myself. In consideration for my employment and my being considered for employment by your credit union, I agree to adhere to the rules and regulations of the credit union and hereby acknowledge that these rules and regulations may be changed by your credit union at any time, at the credit union’s sole discretion, with or without prior notice. I understand and agree that the terms and conditions of my employment may be changed, with or without cause or notice, at any time by the Credit Union. In addition, I acknowledge that my employment may be terminated, and any offer of employment, if such is made, may be withdrawn, with or without prior notice, at any time, at the option of either the credit union or myself. I understand that no representative of the company, other than the CEO or the VP of Human Resources sanctioned by the CEO, has any authority to enter into any agreement for employment for any specified period of time, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or to make any agreement, that is contrary to the foregoing. I hereby acknowledge that I have been advised that this application will remain active for no more than 60 days from the date it is signed. If I am hired, I understand that I will be required to provide proof of identity and legal authorization to work in the United States as required by federal immigration laws. The Credit Union does not tolerate unlawful discrimination or harassment based on sex, race, color, religion, national origin, citizenship, age, disability or any other protected status under applicable federal, state or local law. No questions on this application is used to limit or exclude an applicant from employment consideration or any basis prohibited by applicable federal, state or local law.

Signature*

By entering your name below, you indicate that you have read and agree to the terms of the applicant waiver above.

Date*

Month

Day

Year