Employment Application

* Required Field

General

First Name:*		MI:
Last Name:*
Maiden/Previous Name:
Social Security Number: *
Address:*
City:
State:
ZIP Code:
Previous Address: If at current address less than 2 years
Previous City:
Previous State:
Previous ZIP Code:
Home Phone:*
Cell Phone:
E-mail Address:
Referred By:
Are you under 18 years of age (Work permit needed if under 18):*
Are you under 18 years of age? Yes No
Are you fluent in any language(s) other than English:
Are you fluent in any language(s) other than English? Yes No
If Yes, please indicate which language(s) you speak:

Job Specific Information

Position Applying For: *

Employment Preference:*

Employment Preference Full-Time Part-Time Peak-Time Any

Temporary or Seasonal employment

Rate of Pay Desired:

Rate of Pay Desired Frequency Hour Week Month Year

Date Available to Begin Work:

Days/Hours Available to Work:

Sunday:	to
Monday:	to
Tuesday:	to
Wednesday:	to
Thursday:	to
Friday:	to
Saturday:	to

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

Are you willing to work overtime if requested to do so? Yes No

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

Calculator	Cash Advance Machine	Cash Drawer
Check Encoder	Coin Machine	Fax Machine
Multi-line Switchboard	PC	Printer
Other (Please explain)

List below any personal characteristics, skills, attitudes, or achievements which you feel would qualify you for this position.

Feel free to list any participation in community/civic activities, special achievements, awards, hobbies, etc.

Have you ever been convicted of a felony or misdemeanor, or do you have any charges pending against you: *

Have you ever been convicted of a felony or misdemeanor, or do you have any charges pending against you? Yes No

If yes, please explain:

A conviction or pending charge will not be an automatic bar to employment and will be considered only as it relates to the job in question.

Have you ever paid a civil forfeiture or fine for a non-traffic related offense:*

Have you ever paid a civil forfeiture or fine for a non-traffic related offense? Yes No

If yes, please explain:

Payment of a civil forfeiture or fine will not be an automatic bar to employment and will be considered only as it relates to the job in question.

Education History

High School
Name/Address:*
Major:
Last year completed:*	Last year completed 1 2 3 4
Did you graduate:*	Did you graduate Yes No
Degree:
Business/Trade School
Name/Address:
Major:
Last year completed:	Last year completed 1 2 3 4
Did you graduate:	Did you graduate Yes No
Degree:
College
Name/Address:
Major:
Last year completed:	Last year completed 1 2 3 4 5 6
Did you graduate:	Did you graduate Yes No
Degree:
Graduate Studies
Name/Address:
Major:
Last year completed:	Last year completed 1 2 3 4 5 6
Did you graduate:	Did you graduate Yes No
Degree:
Other
Name/Address:
Major:
Last year completed:	Last year completed 1 2 3 4
Did you graduate:	Did you graduate Yes No
Degree:

Employment History

No previous employer

Starting with the present or most recent, list all previous employers. Include self-employment, military service, summer and part-time jobs.
Employer 1
Company Name:*
Company Address:*
City:
State:
ZIP Code:
Position:*
Length of Employment:*	to
Reason for Leaving:*
May we contact this employer:*	May we contact this employer? Yes No
Name and Title of Supervisor: *
Phone Number:*
E-mail:
Duties: *
Employer 2
Company Name:
Company Address:
City:
State:
ZIP Code:
Position:
Length of Employment:	to
Reason for Leaving:
May we contact this employer:	May we contact this employer? Yes No
Name and Title of Supervisor:
Phone Number:
E-mail:
Duties
Employer 3
Company Name:
Company Address:
City:
State:
ZIP Code:
Position:
Length of Employment:	to
Reason for Leaving:
May we contact this employer:	May we contact this employer? Yes No
Name and Title of Supervisor:
Phone Number:
E-mail:
Duties:
Employer 4
Company Name:
Company Address:
City:
State:
ZIP Code:
Position:
Length of Employment:	to
Reason for Leaving:
May we contact this employer:	May we contact this employer? Yes No
Name and Title of Supervisor:
Phone Number:
E-mail:
Duties:

References

List the names of persons not related to you, who know of your work or qualifications.
Reference 1
Name:
Relationship:
Phone:
Reference 2
Name:
Relationship:
Phone:
Reference 3
Name:
Relationship:
Phone:

Employee Application Authorization

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 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 pre-employment physical examination and such future examinations as may be required by First Federal Savings Bank, which may include 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

Employment Application

General

Job Specific Information

Education History

High School

Business/Trade School

College

Graduate Studies

Other

Employment History

Employer 1

Employer 2

Employer 3

Employer 4

References

Reference 1

Reference 2

Reference 3

Employee Application Authorization