AT WILL EMPLOYMENT APPLICATION

(Void after 60 days)
All qualified applicants will receive consideration for employment and will not be discriminated against based on their race, gender, disability, veteran status, or other protected classification.
PERSONAL
Last Name
First
Middle
Date
Email Address
Street Address
Home Telephone
City
State
ZIP
Business Telephone
Previous Street Address
Cell Phone
City
State
ZIP
 
Position Desired
Full Time
Part Time
Pay Expected
Name of Referral Source
Will you work overtime if asked?
Yes         No
Are you currently authorized to be employed in the U.S.?
Yes         No
When will you be available to begin work?
If you are selected for hire, you will be required to provide documentary evidence of your identity and eligibility to work in the United States.
NOTICE: EVB does conduct a pre-employment criminal and background investigation.
Are you over 18 years of age?
Yes         No
EDUCATION
School Name and Location of School Course of Study No. of Years Completed Did you
Graduate?
Degree or
Diploma & GPA

Graduate Yes
No
College Yes
No
Business/Trade/
Technical
Yes
No
High School Yes
No
Elementary Yes
No
EMPLOYMENT RECORD
List last four (4) employers, starting with present or most recent. Please fully complete and do not use the term "See Resume."
1. Employer
Dates Employed Work Performed
Address
From
To
Telephone Number(s)
Job Title
Supervisor
Hourly Rate/Salary
Reason for Leaving
Starting
Final

2. Employer
Dates Employed Work Performed
Address
From
To
Telephone Number(s)
Job Title
Supervisor
Hourly Rate/Salary
Reason for Leaving
Starting
Final

3. Employer
Dates Employed Work Performed
Address
From
To
Telephone Number(s)
Job Title
Supervisor
Hourly Rate/Salary
Reason for Leaving
Starting
Final

4. Employer
Dates Employed Work Performed
Address
From
To
Telephone Number(s)
Job Title
Supervisor
Hourly Rate/Salary
Reason for Leaving
Starting
Final

Are you currently employed? Yes         No
If yes, may we contact your employer? Yes         No
Summarize special skills and qualifications acquired from employment or other experience
Which business machines, computer equipment and software can you operate proficiently?
Membership in Professional or Civic Organization (exclude those which may disclose your race, color, religion or national origin).
 
GENERAL INFORMATION
Have you previously applied for employment with the Bank?      Yes     No
If yes, when?

Have you previously been employed at the Bank?      Yes     No
If yes, when?

Are any of your relatives employed by the Bank?      Yes     No
If yes, please list name and department:

Have you ever been convicted or plead guilty to a crime?      Yes     No
If yes, please identify the crime, conviction date, and place (jurisdiction), where the conviction was made:

Please include any other information you may think would be helpful in considering you for employment, including additional work experience, articles/books published, activities, accomplishments and so forth. Exclude all information indicative of age, sex, race, religion, color, national origin, and disability.
REFERENCES
Give the names of three persons not related to you, who are familiar with your work performance and have known you at least one (1) year. Include the name of at least one supervisor.
Name Address Phone Relationship

1) Supervisor
2)
3)
 
CERTIFICATION
Please read the following statements before signing. If you have any questions, please discuss them with a Human Resources representative before signing.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that falsified statements during the application and/or interview process will result in removal from consideration or could result in immediate dismissal if employment has already commenced.

If hired, I agree to comply with the policies and procedures of the Bank. I understand that employment will be conditioned upon my mental and/or physical ability to perform the job with or without reasonable accommodation.

I authorize investigation of all statements and referenced contained herein, all information concerning my previous employment, any pertinent information, personal or otherwise and release all parties from all liability for any damage that may result from furnishing this information. Additionally, I authorized the Bank to supply my employment record, in whole or in part, and to any prospective employer, government agency, or other party, with a legal and proper interest and I release the Bank from all claims related to its providing such information.

In accordance with the provisions of the Fair Credit Reporting Act, the Bank may obtain an Investigative consumer report and/or consumer report about me which may include information as to my character, general reputation and personal characteristics from personal acquaintances or others who have knowledge and/or information from a consumer reporting agency bearing on my creditworthiness, credit standing, credit capacity, general reputation and personal characteristics. Within a reasonable time of the receipt of this notification, I may request in writing a disclosure of the nature and scope of any such investigation. I hereby authorize such consumer report and/or investigative consumer report for employment purposes and acknowledge receipt of a copy of the Fair Credit Reporting Act disclosure on a separate document as required by law.

Employment is contingent on satisfactory completion of a credit check, validated skills test if required, past employment references and approval of the surety bonding company. I understand and agree that I must successfully pass and pre and/or post employment drug screen as a condition of employment, if required.

I understand and agree that if hired, my employment is for no definite period and may, regardless of the date of payment of my wages, be terminated at any time without prior notice. I agree that if hired my continued employment may be conditioned upon my taking a polygraph examination for the purpose of resolving a job related matter.
CONSUMER REPORT & INVESTIGATIVE CONSUMER REPORT
DISCLOSURE & RELEASE AUTHORIZATION
In connection with my application for employment, and if hired, at any time during employment, I understand that a consumer report or an investigative consumer report may be requested that will include information as to my character, work habits, performance and experience, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, information may be requested from public and private sources about my: driving record, court record, education, credentials, credit and references.

If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

The Fair Credit Reporting Act provides you with the right to request, in writing within a reasonable amount of time, a disclosure of the nature and scope of the investigation requested. You are also entitled to a written summary of your rights under the Fair Credit Reporting Act as prepared by the Federal Trade Commission ("Summary of Rights").

For purposes of employment, promotion, reassignment or retention as an employee, I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, or reference, to furnish the information described in the first paragraph of this document. Further, my signature below signifies my authorization for a consumer report and/or an investigative consumer report to be obtained on me as part of the employment process and if hired, at anytime during the tenure of my employment. My signature also signifies that I have received a copy of this Release Authorization and the "Summary of Rights" as required law.

The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release the employer and agents and all persons, agencies and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports.
Last Name: First Name: Middle Name:
Driverís License Number & Issuing State:
Name Appearing on License:
Other Names You Have Used:
Social Security Number:
Home Address:
Summary of Your Rights (pdf)
I acknowledge that I have read and understand the above statements.
This application for employment will remain active for 60 days. Ask the organization representative for details.
Signature      Date
EVB
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.

We comply with government regulations, including affirmative action responsibilities where they apply.

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.

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.
Please Print Date
Last Name
First Name
Middle Name
Telephone Number
  
Street Address
City
State
  
ZIP
Referal Source:
Advertisement
Employment Agency
Friend
Walk-In
Relative
 
Other
APPLICANT DATA RECORD
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.
Gender (check one):     Male     Female
 
Check one of the following Race/Ethnic Groups:
Hispanic or Latino Ethnicity
Other
If other, check one of the following Race/Ethnic Groups:
White
Black or African-American
Asian
Native Hawaiian or other Pacific Islander
Two or more Races
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 a Protected Veteran Yes   No
 
Definitions Ė Protected Veteran is one of the following:
 
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 Veteran means any veteran during the three-year period beginning on the date of such veteranís discharge or release from active duty in the U.S. military, ground, naval or air service.

4. Active - Duty Wartime or Campaign Badge Veteran 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. A replica of that list is enclosed with the annual VETS-100A mailing. A copy of the list also may be obtained by sending an email to helpdesk@vets100.com or by calling (301) 306-6752 and requesting that a copy be mailed to you.
 
   
Description of Ethnicity / Race Categories
 
Hispanic or Latino Ethnicity- A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino)- A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

American Indian or Alaskan Native (Not Hispanic or Latino)- A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Black or African-American (Not Hispanic or Latino)- A person having origins in any of the black racial groups of Africa.

Asian (Not Hispanic or Latino)- A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)- A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Two or More Races (Not Hispanic or Latino)- All persons who identify with more than one of the above five races.