Employment Form:

Last Name: First Name: MI: Date of Application: Street Address: City: State: Zip:

Are you 18 years or older?

Type(s) of Work Desired: Home Phone: Cell Phone: Work Phone: Ext: Email Address:

Are you legally eligible for employment in this country?

Peoples Bank is an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.

Your complete application form will be maintained in our active files for six (6) months from the date of application. You may submit a new application at any time.

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

Dates worked:

From: To: Reason for leaving:

Add Previous Employment 3

Dates worked:

From: To: Reason for leaving:

EDUCATIONAL HISTORY

High School:

School Name: Location (city, state):

Dates Attended:

From: To:

Graduated:

Technical/Trade (after high school):

School Name: Location (city, state): Major Course or Subject:

Dates Attended:

From: To:

Graduated:

Degree:

College (list all attended):

School Name: Location (city, state): Major Course or Subject:

Dates Attended:

From: To:

Graduated:

Degree:

Other education/training

School Name: Location (city, state): Major Course or Subject:

Dates Attended:

From: To:

Graduated:

Degree:

SPECIAL SKILLS

Typing:

Words per Minute:

Computer Skills:

Please list other skills and/or equipment/language experience you have acquired:

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.

Name: Title/Relationship: Street Address: City: State: ZIP: Phone Number (include area code): Name: Title/Relationship: Street Address: City: State: ZIP: Phone Number (include area code):

May We Contact Your Present Employer?

Wage or Salary Required: Date Available:

If any of your educational or employment records are under other than the above name, please provide other names.

Name 1 Name 2

I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company's service, if employed.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.

I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself.