Application For Employment

Call 308-384-5350 or 800-576-4687

Applicants are considered for all positions and employees are treated without regard to age, race, color, sex, national origin, religion, disability, sexual orientation, or gender identity.


Are you at least 18 years of age?

Are you employed now?

May we contact your present employer?

Have you ever been employed here before?

Can you provide proof if hired that you are eligible to work in the United States?

Are you available for work

Have you been convicted of a felony with the last 7 years?

(Conviction will not necessarily disqualify applicant from employment)

Veteran of the U.S. Military Service?

Give name, address and telephone number of three references who are not related to you and are not previous employers.



High School




Employment History

Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin.


Dates Employed


Add Another Employer

Referral Source

Application Statement

These answers are true and complete to the best of my knowledge. The company may investigate all statements contained in this application, and I understand that any false or misleading information provided may result in my immediate discharge, regardless of when discovered. I understand that this application is not a contract of employment and that if hired, regardless of any oral representations to the contrary, the employment relationship between myself and the company may be terminated by either party at any time, with or without cause.

Additionally, I authorize the company to supply my employment record, in its sole discretion, in whole or in part, to any prospective employer, government agency, or other party, with an interest that the company deems appropriate.

Five Points Bank is an Equal Opportunity Employer of women, minorities, protected veterans and individuals with disabilities.

Applicants are active for 60 days only.

Credit/Back Ground Report Authorization Form

As part of the hiring process a Credit and Background Report are required. Applicant will be required to complete the authorization form at the second level of the hiring process.

Applicant Data Record (Voluntary Submission)

Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, creed, sex, national origin, ancestry, age, marital or veteran status, disability or any other legally protected status.

As an employer we comply with government regulations and affirmative action responsibilities.

Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation.

This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.

Affirmative Action Survey (Voluntary Submission)

Government agencies require periodic reports on sex, ethnic, handicapped, disability and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information is voluntary.

Check one

Check one of the following

Race/Ethnic Group

Check if any of the following are applicable

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