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First State Bank Logo

Employment Application

Required Field


Have you lived here for two or more years?
How would you prefer to be contacted?
Are you fluent in any language(s) other than English

Job Specific Information

Which branch location(s) are you applying for?
What is your employment preference?

What days/hours are you able to work?

  • Time AM

  • Time PM

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)

Education History

High School

What was your last year completed?
Did you graduate?

Business/Trade School

What was your last year completed?
Did you graduate?


What was your last year completed?
Did you graduate?

Graduate Studies

What was your last year completed?
Did you graduate?


What was your last year completed?
Did you graduate?

Employment History

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.


May we contact this employer?
Add Another Employer


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

Reference 1

Reference 2

Reference 3


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 State 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 State 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 State 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 State Bank may deny me employment or terminate my employment, and I agree that First State Bank shall not be liable in any respect if it does so. If I am hired, I understand that employment with FSB is at will, meaning that either I or FSB may terminate the employment relationship at any time for any lawful reason without notice. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of FSB is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the president of First State Bank.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

I understand that First State Bank does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I acknowledge that any false, incomplete or misleading information I provide on this application form, in a resume, or in a pre-employment interview will be grounds to deny my application or, if discovered later, for immediate dismissal from employment.