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Employment Application

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability or national origin. Consistent with the Americans Disabilities Act, applicants may request accommodations needed to participate in the application process.

* Required Field
* Social Security Number - -
* Last Name
* First Name
  Middle Name
  Address 1
  Address 2
  City
  State
  ZIP Code
  Email Address
  Phone Number() -
  Referred By
  Are you 18 years of age or older?

Employment Desired

  Position
  Date you can start / / (mm/dd/yyyy)
  Salary Desired ($)
  Are you employed now?

  If so, may be inquire of your present employer?

  If so, where?
  If so, when? / / (mm/dd/yyyy)

Education

Grammar School:

  Name and Location
  Graduated?

  Subjects Studied and Degree(s) Received

High School:

  Name and Location
  Graduated?

  Subjects Studied and Degree(s) Received

College:

  Name and Location
  Last Year Completed
  Graduated

  Subjects Studied and Degree(s) Received

Trade, Business or Correspondence School:

  Name and Location
  Last Year Completed
  Graduated?

  Subjects Studied and Degree(s) Received

General:

  Subjects of Special Study or Research Work
  Job Related Skills (typing, drivers license, etc.)

Former Employers

List below the last three employers, starting with the most recent one first.

  Start Date / / (mm/dd/yyyy)
  End Date / / (mm/dd/yyyy)
  Salary upon Leaving ($)
  Reason for Leaving
  Name of Employer
  Address 1 of Employer
  Address 2 of Employer
  City of Employer
  State of Employer
  ZIP of Employer
  Position

  Start Date / / (mm/dd/yyyy)
  End Date / / (mm/dd/yyyy)
  Salary upon Leaving ($)
  Reason for Leaving
  Name of Employer
  Address 1 of Employer
  Address 2 of Employer
  City of Employer
  State of Employer
  ZIP of Employer
  Position

  Start Date / / (mm/dd/yyyy)
  End Date / / (mm/dd/yyyy)
  Salary upon Leaving ($)
  Reason for Leaving
  Name of Employer
  Address 1 of Employer
  Address 2 of Employer
  City of Employer
  State of Employer
  ZIP of Employer
  Position

References

* Last Name
* First Name
  Middle Name
  Position
  Years Acquainted
  Address 1
  Address 2
  City
  State
  ZIP
  Phone Number() -

* Last Name
* First Name
  Middle Name
  Position
  Years Acquainted
  Address 1
  Address 2
  City
  State
  ZIP
  Phone Number() -

* Last Name
* First Name
  Middle Name
  Position
  Years Acquainted
  Address 1
  Address 2
  City
  State
  ZIP
  Phone Number() -

Please read the following disclosure and scroll down to submit this application.

If you are hired, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

AUTHORIZATION:
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the employer.

I understand that any employment is conditioned on a background check. I authorize the financial institution to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the credit union, without giving me prior notice of such disclosure. In addition, I release the financial institution, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during my interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the financial institution. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the financial institution unless made in writing.

If I am offered employment I agree to submit to a medical examination and drug test, if required, before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the credit union and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the financial institution the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, may be contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the financial institution's Drug and Alcohol Policy.

I understand that filling out this form does not indicate there is a position open and does not obligate the financial institution to hire. If hired, I agree to abide by all financial institution work rules, policies and procedures. The financial institution retains the right to revise its policies or procedures, in whole or in part, at any time.

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Equal Housing Lender National Credit Union Administration
This Credit Union is federally-insured by the National Credit Union Administration. We do business in accordance with the Fair Housing Law and Equal Opportunity Credit Act.