Application for Employment

Hendricks County Bank and Trust Company considers applicants for all positions, without regard to race, color, religion, gender, national origin, age, disability, marital status, veteran status, or any other prohibited basis of discrimination, as provided under applicable state and federal law.

Federal and state law obligates us to provide reasonable accommodations to the known disabilities of applicants and employees, unless to do so would pose an undue hardship. Please let us know if you need an accommodation to complete the application process or to perform any essential elements of the position you are applying for.

DIRECTIONS: Only applications completed in full will be considered. Page 5 applies only to those applying electronically. The affirmative Action Plan Plan Pre-Employment Information (page 6) is voluntary. If completing in hard copy please print.

Position Applying for: Posting # Applying For:
Application Date: Available to Work: Full Time Part Time
       
Last Name First Name Middle Name
Address City State                         Zip
Home Phone Cell Phone Social Security Number
Date Available for Work: Expected Salary:
If you are applying for a part time position, please provide specifics on your available time:
How did you learn about us?
Newspaper Ad Employment Agency Walk-In other;   Specify:
Friend/Relative; Name Website; Specify:
Have you ever been fired or asked to resign from a job?   Yes No
Have you ever been employed with us before?   Yes No
If yes, please provide dates of employment  From to
         
Have you filed an application with us before?   Yes No
If yes, please provide the date of application  
         
If under 18 yrs of age, can you provide proof of your eligibility to work?   Yes No
Do you have any relatives working for Hendricks County Bank and Trust Company?   Yes No
If yes, please provide his/her name(s)  
         
Are you currently employed?   Yes No
If yes, may we contact your present employer?   Yes No
Can you travel if the job requires you to?   Yes No
         
Are you prevented from lawfully becoming employed in this country?   Yes No
Proof of citizenship or immigration status will be required upon employment.        
         
Have you been convicted of a felony?   Yes No
If yes, please explain below:        
         
Are you a veteran of the U.S. Military Service?   Yes No
If yes, please provide which branch  
List below professional, trade, business, or civic activities (other than religious) and offices held.
Exclude those that indicate rate, color, disability, religion, sex, or national origin:
         
List below job related skills and qualifications acquired from employment or other experiences.
         
List below any honors or certifications you have received while receiving your education or during your employment.
References: List 3 references other than relatives. References should have some knowledge of your work experience and educational background.
Name Address Phone
EDUCATION
  School Name City & State Did you graduate?
High School Yes No
College Yes No
If attended, list course of study and degree received:
Graduate Yes No
If attended, list course of study and degree received:
Trade/Other Yes No
If attended, list course of study and degree received:
EMPLOYMENT HISTORY
List last 3 employers, assignments, or volunteer activities, chronologically (most recent first) and with no omissions, including military experience.
Employer Name
Address
City, State & Zip
Employer Phone
Your Job Title
Dates Employed
Hourly Rate/Salary
Supervisor Name
Reason for Leaving
Work Performed:
     
Employer Name
Address
City, State & Zip
Employer Phone
Your Job Title
Dates Employed
Hourly Rate/Salary
Supervisor Name
Reason for Leaving
Work Performed:
     
Employer Name
Address
City, State & Zip
Employer Phone
Your Job Title
Dates Employed
Hourly Rate/Salary
Supervisor Name
Reason for Leaving
Work Performed:
     
Affirmative Action
Voluntary Information

We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve/national guard or any other similarly processed status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.


To be completed by applicant on a voluntary basis. Not for interview purposes. To be filed separately from application

In an effort to comply with requirements regarding government recordkeeping, reporting and other legal obligations which may apply, we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will not subject you to any adverse personnel decision or action. Your cooperation is appreciated

Please be advised that this survey is not part of your official application for employment. It will not be used in any hiring decision.

The information will be used and kept confidential in accordance with applicable laws and regulations.

Position(s) applied for:
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Name of person who referred you (if applicable)

   
Applicant Information
Last Name First Name Middle Telephone
Address City State Zip
Male Female      
Please check on of the following Equal Employment Opportunity Identification Groups:
American Indian / Alaskan Native Hispanic / Latino (White race only) White Black / African American
Native Hawaiian / Other Pacific Islander Hispanic / Latino (all other races) Asian    

PLEASE READ CAREFULLY BEFORE SUBMITTING

This application for employment shall be considered active for 30 days. Any applicant wishing to be considered for employment beyond this time period should reapply.

By signing below, I certify that the answers and information provided are true, accurate and complete to the best of my knowledge. I acknowledge that if any answer or information is not true, accurate or complete, I may not be hired, or if hired, I may be discharged. I authorize Hendricks County Bank and Trust Company to investigate all statements contained in this application for employment and to investigate my character and qualifications. I authorize my prior employers, references, and others with information regarding my work or education history or my character, to provide Hendricks County Bank and Trust Company with all requested information and references, and to cooperate fully with the investigation of my character and qualifications.

I understand that this application is not a contract of employment. I also acknowledge that no oral representations have been made, and that no one within Hendricks County Bank and Trust Company has the authority to make oral contracts of employments. If hired, my employment relationship with Hendricks County Bank and Trust Company is terminable at-will, with or without cause, by either myself or Hendricks County Bank and Trust Company.

I also understand that any offer of employment may be conditional upon my passing a pre-employment physical examination and drug/alcohol test administered by a health care professional selected by Hendricks County Bank and Trust Company, to which I hereby consent.

I understand and agree to all the conditions and statements set forth above, and throughout this application.


Hendricks County Bank and Trust Company
CONSENT TO RECEIVE ELECTRONIC COMMUNICATIONS

If you are not submitting your application electronically, you may skip this page and move on to the next page of this document.

If submitting your Application for Employment electronically by email, this document informs you of your rights regarding the receipt of legally-required disclosures, notices, consents and information associated with your application to Hendricks County Bank and Trust Company.

The hardware and software requirements needed to access to and retention of the electronic records include: Internet Explorer 4.0 or above, Netscape Navigator 4.0 or above, Microsoft Word, and hardware capable of running this software.

In order to submit your Application for Employment with Hendricks County Bank and Trust Company electronically via email, we need your consent. By completing and emailing your application to Hendricks County Bank and Trust Company you:

  • Acknowledge receipt of this document and consent to the electronic delivery of such disclosures.

  • Consent to receive communications and disclosures related to the processing of your Application for Employment with Hendricks County Bank and Trust Company in electronic form. This consent includes any disclosures required by federal, state or local law, including, but not limited to, disclosures under the federal Fair Credit Reporting Act.

  • Can access the electronic disclosures in the designated formats described herein.

  • Consent to having all disclosures from Hendricks County Bank and Trust Company provided or made available to you in electronic form.

After submitting this Application for Employment and accompanying Release Authorizations electronically via email, you may withdraw your consent by informing Hendricks County Bank and Trust Company in writing to: Hendricks County Bank and Trust Company, P.O. Box 230 Brownsburg IN 46112, Attention Human Resources. If you decide to withdraw your consent, the legal validity and enforceability of prior electronic disclosures will not be affected, and you will no longer be considered for employment.

If you would like a paper copy of this Application for Employment packet, you may print this document or visit us at the above address.


Hendricks County Bank and Trust Company
CREDIT AND BACKGROUND CHECK RELEASE AUTHORIZATION

Name:
  Last First Middle Initial
Maiden/Previous Name:
  Last First
 
  Social Security Number Date of Birth mm/dd/yy
Address:
  Street  
 
  City State Zip

In connection with my application for employment, or continued employment, I authorize any credit bureau, insurance company, employer, former employer, educational institution, law enforcement organization, state and federal government agency, information service bureau, and other persons contacted to release information regarding my driving history, criminal records, records, investigative consumer report, character, performance, qualifications, background and reasons for termination of past employment to requesting Employer or its agents from any responsibility or liability, and also any injuries or damages not now known or which may later develop, resulting from the disclosure of such information.

I also authorize the release of my driving history, criminal records, employment and educational histories, and investigative consumer report and understand that it may contain information about my background, mode of living, character, and personal reputation. I acknowledge that a telephone facsimile or photographic copy shall be as valid as the original. I understand that the decision to hire is solely that of the Employer.

I realize and agree that this information may be obtained prior to my employment or during my employment with Hendricks County Bank and Trust Company. I also realize that this information may be obtained for internal security reasons and hereby consent to this policy as a term and condition of employment.


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