Progressive Bank hereinafter referred to
as the "Bank" appreciates your interest. The
Bank provides all employees and applicants
equal opportunity for employment without
regard to race, color, sex, age, religion,
national origin, marital status, and to
disabled veterans, veterans of the Vietnam
era, other covered veterans, and individuals
with a disability, and any other
characteristics protected by Federal, State
or Local law.
In connection with this application, the
undersigned hereby authorize and instructs
Progressive Bank to:
I authorize and instruct any and all
persons, consumer reporting agencies and
other parties to make such inquires as may
be appropriate and to compile and furnish
such information to the Bank in connection
with this application for employment.
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 Bank.
THE APPLICATION MUST BE COMPLETED IN FULL.
Use the space below to describe the
skills and personal attributes that you feel
qualify you for a position with our bank.
Please tell why you are interested in being
employed with the bank.
Indicate any extracurricular activities
in which you participated and any awards or
special recognition you may have received
during school or since leaving school that
you feel would be relevant to the position
for which you are applying.
List below all present and past
employment, beginning with your most recent
employment, for the last 10 years or years
worked if less than 10 years.(Include
self-employment, summer, and part-time
List any other experience, skills or
other qualifications, including hobbies,
which you believe should be considered in
evaluating your qualifications for
employment. Please indicate any prior
military service that you would like
considered in connection with your
application for employment.
PLEASE READ THE FOLLOWING CONDITIONS OF
EMPLOYMENT AND CERTIFY BY YOUR SIGNATURE
THAT YOU UNDERSTAND AND AGREE TO THESE
I CERTIFY THAT ALL ANSWERS GIVEN
BY ME ARE TRUE, ACCURATE AND COMPLETE. I
UNDERSTAND THAT THE FALSIFICATION,
MISREPRESENTATION OR OMISSION OF FACT ON
THIS APPLICATION (OR ANY OTHER ACCOMPANYING
OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR
DENIAL OF EMPLOYMENT OR IMMEDIATE
TERMINATION OF EMPLOYMENT, REGARDLESS OF
WHEN OR HOW DISCOVERED.
Questions regarding this statement should
be directed to the Human Resources
Department before signing. The application
will be given every consideration, but its
receipt does not imply that the applicant
will be employed.
I authorize the investigation of all
statements and information contained in this
application. I release from all liability
anyone supplying such information and I also
release the employer from all liability that
might result from making an investigation.
If hired, I agree to abide by all of the
company policies, rules and regulations, and
understand that, if employed, my employment
may be terminated with or without cause, and
with or without notice, at any time, at the
option of either the Bank or me. It is my
understanding that I could be subject to a
polygraph test while employed by the Bank.
I further understand that no
representation, whether oral or written by
any representative or agent of the Bank, at
any time, can constitute a contract of
employment. I understand that the Bank and
all Plan Administrators shall have the
maximum discretion permitted by law to
administer, interpret, modify, discontinue,
enhance or otherwise change all policies,
procedures, benefits or other terms or
conditions of employment.
I understand that Progressive Bank is an
'at-will' employer and operates under the
provision that employees have the right to
resign their positions at any time, with or
without cause. Progressive Bank has similar
rights to terminate the employment
relationship at any time, with or without
notice, and with or without cause.
No representative or agent of the Bank
has the authority to enter into any
agreement for employment for any specified
period of time or to make any change in any
policy, procedure, benefit or other term or
condition of employment other than in a
document signed by the President of
Progressive Bank, or to make any agreement
contrary to the foregoing.
The application is current for 60
days from the date signed. At the conclusion
of the 60 days, if I wish to continue to be
considered for employment, it will be
necessary for me to complete a new
I acknowledge that I have read and
understand the above statements and hereby
grant permission to confirm the information
supplied on this application by me.
By typing my name, I confirm this
Please read the following evaluation
scale carefully and enter the most
appropriate number in the spaces provided
next to each skill/task. Incomplete or
incorrectly completed supplements will not
3 = Extensive Skill and
Experience: Have performed task
extensively in a work setting. No
2 = Moderate Skill:
Have performed this function and/or used
this skill. Limited orientation needed.
1 = Minimal Skill:
Intermittent /occasional use or
classroom training only.
0 = Unskilled: if you
have no experience or have never
Certification: I certify that all of the
statements made are true, complete and
correct to the best of my knowledge and
belief and are made in good faith. I
understand that I may be expected to
substantiate these self-ratings if invited
To The Applicant:
In accordance with the Consumer Credit
Report Reform Act of 1997, the following
disclosure must be signed by you, the
applicant, authorizing a consumer report
and/or an investigative consumer report as
part of our application process and
consideration for employment.
In processing my application for
employment I hereby authorize Progressive
Bank to procure or have prepared consumer
reports and/or investigative consumer
reports about me. I understand that, in
connection with investigative consumer
reports, information may be obtained through
personal interviews with my neighbors,
friends, associates, or others with whom I
am acquainted regarding my character,
general reputation, personal
characteristics, and mode of living.
Upon my request to Progressive
Bank, I will be informed of whether a
consumer report was requested and, if so, of
the name and address of the consumer
reporting agency that furnished the report.
Upon my written request to Progressive Bank,
I will be informed of whether an
investigative consumer report was requested
and, if so, of the name and address of the
consumer reporting agency to whom the
request was made, together with complete and
accurate disclosure as to the nature and
scope of the investigation. I further
understand that, if I am granted employment,
Progressive Bank and/or companies affiliated
with it may subsequently, from time to time,
request consumer reports, other than
investigative consumer reports in connection
with my employment.
This company is an Equal Opportunity Employer. We do not discriminate in hiring or employment because of
race, color creed, national origin, sex, age, disability or veteran status. Various government agencies request
statistical information regarding our hiring practices. Your cooperation in completing this section is
completely voluntary. Any information gathered is strictly confidential. Your answers will in no way be
used against you. Thank you for your cooperation.
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to
qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if
you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will
choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used
against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may
become disabled at any time, we are required to ask all of our employees to update their information every five
years. You may voluntarily self-identify as having a disability on this form without fear of any punishment
because you did not identify as having a disability earlier.
You are considered to have a disability if you have a physical or mental impairment or medical condition that
substantially limits a major life activity, or if you have a history or record of such an impairment or medical
Disabilities include, but are not limited to:
Please check one of the boxes below:
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.
Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples
of reasonable accommodation include making a change to the application process or work procedures,
providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal
employment obligations of Federal contractors, visit the U.S. Department of Laborís Office of Federal Contract
Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond
to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5
minutes to complete.
1. PROGRESSIVE BANK is a Government contractor subject to the Vietnam Era Veteransí
Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38
U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to
employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3)
active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans.
These classifications are defined as follows:
Protected veterans may have additional rights under USERRAóthe Uniformed Services
Employment and Reemployment Rights Act. In particular, if you were absent from employment
in order to perform service in the uniformed service, you may be entitled to be reemployed by
your employer in the position you would have obtained with reasonable certainty if not for the
absence due to service. For more information, call the U.S. Department of Laborís Veterans
Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.
2. As a Government contractor subject to VEVRAA, we are required to submit a report to the
United States Department of Labor each year identifying the number of our employees belonging
to each specified "protected veteran" category. If you believe you belong to any of the categories
of protected veterans listed above, please indicate by checking the appropriate box below.
I BELONG TO THE FOLLOWING CLASSIFICATIONS OF PROTECTED VETERANS
(CHOOSE ALL THAT APPLY):
If you are a disabled veteran it would assist us if you tell us whether there are accommodations
we could make that would enable you to perform the essential functions of the job, including
special equipment, changes in the physical layout of the job, changes in the way the job is
customarily performed, provision of personal assistance services or other accommodations. This
information will assist us in making reasonable accommodations for your disability.
3. Submission of this information is voluntary and refusal to provide it will not subject you to
any adverse treatment. The information provided will be used only in ways that are not
inconsistent with the Vietnam Era Veteransí Readjustment Assistance Act of 1974, as amended.
4. The information you submit will be kept confidential, except that (i) supervisors and managers
may be informed regarding restrictions on the work or duties of disabled veterans, and regarding
necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the
extent appropriate, if you have a condition that might require emergency treatment; and (iii)
Government officials engaged in enforcing laws administered by the Office of Federal Contract
Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.
5. Progressive Bankís various action oriented programs help Progressive Bank maintain equal
employment opportunity in the workforce, reaffirming its commitment to the spirit and letter of
affirmative action law.
If you would like
a copy of this completed application, please
print this page before clicking submit.
If you would like to
submit a resume in addition to your
application, please e-mail it to