Employment Application

Required Field

Applicant

First Name Middle Initial Last Name Maiden/Previous Name Suffix Social Security Number Birth Date Home Address City State Zip Code

Have you lived here for two or more years?

Previous Home Address City State Zip Code Daytime Phone Number Home Phone Number E-mail Address

How would you prefer to be contacted?

Home Phone
Daytime Phone
Email
Other
Other Preference

Referred By

Are you under 18 years of age?

Work permit needed if under 18

Are you fluent in any language(s) other than English

Yes
No
What other languages do you speak?

Job Specific Information

Position Applying For

Which branch location(s) are you applying for?

Any
Mascoutah
New Baden
Lebanon

What is your employment preference?

Any
Full-Time
Part-Time
Temporary or Seasonal employment

Desired Pay Rate Rate Per (Hour, Month, or Year) Date Available to Begin Work

What days/hours are you able to work?

Time AM
Time PM

Sunday from
to

Monday from
to

Tuesday from
to

Wednesday from
to

Thursday from
to

Friday from
to

Saturday from
to

Are you willing to work overtime if requested to do so?

Are you an experienced operator of any of the following? (Select all that apply)

If other please explain List any personal characteristics, skills, attitudes, or achievements which you feel would qualify you for this position.

Have you been employed before?

Starting with the present or most recent, list all previous employers. Include self-employment, military service, summer and part-time jobs.

Employer

Employer Name Address City State Zip Code Last Position Held Employment Start Date Employment End Date (Today's date if current employer) Reason for Leaving Job Duties Name and Title of Supervisor Phone Number E-mail

May we contact this employer?

 Add Another Employer

References

List the names of persons not related to you, who know of your work or qualifications.

Reference 1

First Name Last Name Phone Number

Reference 2

First Name Last Name Phone Number

Reference 3

First Name Last Name Phone Number

Endorsement

I certify that the facts set forth in this application are true, correct and complete without misrepresentations or omissions of any kind whatsoever. I authorize investigation of the statements I have made herein. I hereby release from any and all liability all representatives of First Federal Savings Bank for their acts performed in connection with evaluating my application, background, credentials and qualifications. I hereby further authorize any party (including the companies, schools and organizations listed in this application form) to release any information they may have about me to First Federal Savings Bank, including all of my personnel records with prior employers. I also release all persons, companies, schools and organizations (and all persons connected with them) who provide such information to First Federal Savings Bank from any and all liability for any damage for giving this information. I understand that if any of the information on this application form is discovered to be incorrect, false or misleading or if there are any misrepresentations or omissions of and kind whatsoever, then First Federal Savings Bank may deny me employment or terminate my employment, and I agree that First Federal Savings Bank shall not be liable in any respect if it does so. I also understand that my employment at First Federal Savings Bank is contingent upon the satisfactory completion of a drug screen and an investigation of my work record and references. I consent to a drug screening. I understand that if I am employed by First Federal Savings Bank, any such employment is not binding on either party for any specific period of time. I further understand that no representative of First Federal Savings Bank, other than the CEO or President, has any authority to enter into any agreement for employment for any specified period of time. Any such agreement must be in writing and signed by such officer. I understand that any other written or oral statement to the contrary, even if made by a supervisor, manager or officer of First Federal Savings Bank, is invalid and should not be relied on by me. I understand that if employed I will be an employee-at-will and that either First Federal Savings Bank or I may terminate that employment relationship at any time, for any reason, with or without notice.

I acknowledge that I have read and understand the Employee Application Authorization. Applicant's Signature Date

Applicant

Job Specific Information

What days/hours are you able to work?

Time AM

Time PM

Education History

High School

Business/Trade School

College

Graduate Studies

Other

Employment History

Employer

References

Reference 1

Reference 2

Reference 3

Endorsement