Employment Application

First National Bank-Fox Valley considers all applicants for positions, without regard to race, color, religion, gender, national origin, citizenship, age, disability, marital status, veteran status, or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of unlawful criteria. Information on this application is strictly confidential. In addition to enabling us to evaluate you as a prospective employee, it will also serve as a permanent record should you be employed by the First National Bank-Fox Valley. THE APPLICATION MUST BE COMPLETED IN FULL.

*Last Name:
*First Name: MI:
*Date of Application: 4 digit year
*Street Address:
*City:
*State:
*Zip: -
*Are you 18 years or older? Yes No
*Home Phone:
 Work Phone: Ext:
 Cell Phone:
 Email Address:
*Are you legally eligible for employment in this country? Yes No
* If any of your educational or employment records are under other than the above name, please provide other names.
* Position Desired:
* Date Available:
* Wage or Salary Desired:
* 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?
* Have you ever been convicted of or plead guilty to a crime? Yes No
If yes, please identify the crime, conviction date, and place (jurisdiction), where the conviction was made:

EMPLOYMENT RECORD

Starting with present or most recent, list all previous employers. Include self-employment and summer and part-time jobs. You may attach a resume, but complete this application as well.

Last or Present Company:
Type of Business:
Type or Classification of Job:
Street Address:
City:
State:
Zip: -
Phone Number:
Brief Description of Job Duties:
Supervisor's Name:
Phone Number:
Base Salary:
Dates Worked: From: To:
Reason for Leaving:
Add Previous Employment 2
Last or Present Company:
Type of Business:
Type or Classification of Job:
Street Address:
City:
State:
ZIP: -
Phone Number:
Brief Description of Job Duties:
Supervisor's Name:
Phone Number:
Base Salary:
Dates worked: From: To:
Reason for leaving:
Add Previous Employment 3
Last or Present Company:
Type of Business:
Type or Classification of Job:
Street Address:
City:
State:
ZIP: -
Phone Number:
Brief Description of Job Duties:
Supervisor's Name:
Phone Number:
Base Salary:
Dates worked: From: To:
Reason for leaving:
Add Previous Employment 4
Last or Present Company:
Type of Business:
Type or Classification of Job:
Street Address:
City:
State:
ZIP: -
Phone Number:
Brief Description of Job Duties:
Supervisor's Name:
Phone Number:
Base Salary:
Dates worked: From: To:
Reason for leaving:
* 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:

EDUCATIONAL HISTORY

High School:  
School Name:
Location (city, state):
Dates Attended: From: To:
Graduated: Yes No
 
Technical/Trade (after high school):  
School Name:
Location (city, state):
Major Course or Subject:
Dates Attended: From: To:
Graduated: Yes No
Degree:
College (list all attended):  
School Name:
Location (city, state):
Major Course or Subject:
Dates Attended: From: To:
Graduated: Yes No
Degree:
 
School Name:
Location (city, state):
Major Course or Subject:
Dates Attended: From: To:
Graduated: Yes No
Degree:
Other education/training  
School Name:
Location (city, state):
Major Course or Subject:
Dates Attended: From: To:
Graduated: Yes No
Degree:

PROFESSIONAL/WORK REFERENCES

List two past supervisors and one person who is not related to you who have knowledge of your qualifications for the position for which you are applying.
Reference 1  
Name:
Title/Relationship:
Street Address:
City:
State:
ZIP: -
Phone Number (include area code):
Reference 2  
Name:
Title/Relationship:
Street Address:
City:
State:
ZIP: -
Phone Number (include area code):
Reference 3  
Name:
Title/Relationship:
Street Address:
City:
State:
ZIP: -
Phone Number (include area code):

APPLICANT STATEMENT

I certify that all information I have provided in order to apply for and secure work with First National Bank-Fox Valley is true, complete and accurate.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) cancel further consideration of this application, (2) immediately discharge me from First National Bank-Fox Valley, whenever it is discovered.

I hereby authorize, without reservation, First National Bank-Fox Valley, its representatives, employees or agents, to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that First National Bank-Fox Valley does not unlawfully discriminate in employment and no questions on this application are used for the purpose of limiting or excusing any applicant from consideration for employment on the basis prohibited by applicable local, state or federal law.

I understand that this application remains active for 60 days. At the conclusion of that time, if I have not heard from First National Bank-Fox Valley and still wish to be considered for employment, it will be necessary to reapply and complete a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause, and without prior notice, and First National Bank-Fox Valley reserves the same right to terminate my employment at any time, with or without cause, and without prior notice, except as may be required by law. 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 First National Bank-Fox Valley is authorized to make any assurance to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid.