Employment Application

We consider applications for all positions without regard to race, color, creed, gender, national origin, age, disability, sexual orientation, citizenship status, genetic information or any other legally protected status.

Applicant Information

Full Name:
Last
First
M.I.		 Date:
Address:
Street Address
Apartment/Unit #
 
City
State
Zip Code
Phone: Email:
Date Available: Social Security No.: Desired Salary: $
Position Applied for:

Please indicate your availability: Full-Time Part-Time Temporary
Please indicate dates available for work:

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship will be required upon employment. YES
 NO
 
Are you currently on "lay-off" status and subject to recall? YES
 NO
If you are 18 years of age, can you provide the required proof of your eligibility to work? YES
 NO
 
Can you travel if a job requires it? YES
 NO
Have you ever worked for this company? YES
 NO
 
If yes, when?
Have you ever filed an application with us? YES
 NO
 
If yes, when?
Do any of your friends or relatives, other than spouse, work here? YES
 NO
 
If yes, who?
May we contact your employer? YES
 NO
 

What is your desired Salary Range?

Education

High School: Address:
From: To: Did you graduate? YES
 NO
 Diploma:
College: Address:
From: To: Did you graduate? YES
 NO
 Diploma:
Other: Address:
From: To: Did you graduate? YES
 NO
 Diploma:

References

Please list three professional references.

Full Name: Relationship:
Company: Phone:
Address:
Full Name: Relationship:
Company: Phone:
Address:
Full Name: Relationship:
Company: Phone:
Address:

Previous Employment

Company: Phone:
Address: Supervisor:
Job Title: Starting Salary: $ Ending Salary: $
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference? YES
 NO
  
Company: Phone:
Address: Supervisor:
Job Title: Starting Salary: $ Ending Salary: $
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference? YES
 NO
  
Company: Phone:
Address: Supervisor:
Job Title: Starting Salary: $ Ending Salary: $
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference? YES
 NO
  

Describe any job-related training received in the United States Military

Describe any specialized training, apprenticeship skills and extra-curricular activities.

List professional, trade, business, or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

Additional Qualifications.

State any additional skills or qualifications you feel maybe helpful to us in considering your employment.

Can you perform the essential functions of the job, for which you are applying, with or with out a reasonable accommodation?

Please do not answer this question if you have not been informed of the requirements of this position.

Yes No

 

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 60 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at this time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at anytime with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by authorized executive of the organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature: Date:

Amboy Bank Applicant Data Record

Applicants and Employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap/disability, or any other legally protected status.   Solely to help us comply with governmental record keeping, reporting and other legal requirements, we request that you please fill out the Applicant Data Record. We appreciate your cooperation.
We comply with government regulations, including affirmative action responsibilities where they apply.   This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment. YOUR COOPERATION IS VOLUNTARY.

Date:  

Position Applied For:
Name:
Last
First
Middle		 ()
Area Code		 Phone:
Address:
Number
Street
City
State
Zip Code

Referral Source:

  Advertisement Friend Relative
  Employment Agency Walk In Other

Confidential Voluntary Survey

Various government agencies request statistical information regarding our hiring practices. Your cooperation in completing this form is completely voluntary. Any information gathered is strictly confidential and will not subject you to coercion or intimidation relating to your status. Failure to provide this information will not adversely affect your application. Thank you for your cooperation.

Check One:
Male Female

Check one of the following Race/Ethnic Groups:
Hispanic or Latino Other

If other, check one of the following Race/Ethnic Groups:
White Black or African American Asian Two or more Races
Native Hawaiian or Other Pacific Islander Native American Indian/Alaskan Native

If Native American Indian, check if any of the following are applicable:
Formal member of a particular tribe Have a membership card issued by the tribe
Have a Certificate of Degree of Indian Blood issued by the Bureau of Indian Affairs
Are considered an American Indian in your community
Used American Indian School or hospital

I am:  
  1. A Disabled Veteran Yes No
  2. An Armed Forces Service Medal Veteran Yes No
  3. A Recently Separated Veteran Yes No
  4. An Active Duty Wartime or Campaign Badge (Other Protected) Veteran Yes No

Definitions:

  1. A Disabled Veteran means (i) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (ii) a person who was discharged or released from active duty because of a service-connected disability.
  2. Armed Forces Service Medal Veteran means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg. 1209) at http://www.opm.gov/veterans/html/vgmedal2.asp
  3. Recently Separated Veterans means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service.
  4. Active Duty Wartime or Campaign Medal (Other Protected) Veterans means a veteran who served on active duty in the U.S. military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized. For those with Internet access, the information required to make this determination is available at http://www.opm.gov/veterans/html/vgmedal2.htm Information also may be obtained by sending an email to helpdesk@vets100.com or by calling (301) 306-6752.

 

 

AMBOY BANK IS AN EQUAL OPPORTUNITY EMPLOYER OF WOMEN, MINORITIES, PROTECTED VETERANS, AND INDIVIDUALS WITH DISABILITIES.