Name:
Date

 

Office Use Only Date
Application #  

Application For Employment


Employment Information

Progressive Bank hereinafter referred to as the ďBankĒ 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.

Authorization for Consumer Credit Reports and Investigative Consumer Reports

In connection with this application, the undersigned hereby authorize and instructs Progressive Bank to:

  1. Make such inquiries and investigations as may be deemed necessary or appropriate;
  2. Contact, question and interview persons who are not consumer reporting agencies;
  3. Secure consumer reports or investigative consumer reports.

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.


Accept   Decline

 


 

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.

Personal Data


Legal Name: (First, Middle, Last)
Social Security No.
- -
 
Present Address:
 
City
State
Zip
       
Length of time at this address:  years
 
months
List previous addresses for which you have resided in the last 5 years within the United States:
       
Home Phone:
- -
Work Phone:
- -
       
Mobile/Other Phone:
- -
Email Address:
       
How were you referred to us? Please include name of source.
Advertisement
Walk - in
Employee
Employment Agency
Relative
Other
       
Are you under the age of 16? Yes No
       
Are you legally eligible for employment in the United States? Yes No
(Proof of citizenship or immigration status will be required upon employment)
       
Do you have any friends or relatives working at this bank? Yes No
If yes, list the name(s) and relationship:
       
Have Progressive Bank or its affiliates employed you previously? Yes No
If yes, at what location and approximate date?
       
Have you ever been bonded? Yes  No    If yes, When?
For what position?
       
Have you ever been refused bonding? Yes  No   
If yes, please explain
       
Have you ever been convicted of a felony or misdemeanor other than a minor traffic violation? Yes  No   
If yes, state offense(s), date(s), and location(s):
       
Have you worked or attended school under another name? Yes  No   
If yes, provide other name(s)

General Position Information



Position desired: 1st Choice
2nd Choice
     
Do you want to work: Full-time Part-time
     
Date available to work? / /    Desired salary $ per
     
Hours of the day available to work:

  EXAMPLE Monday Tuesday Wednesday Thursday Friday Saturday/Sunday
A.M. 7:00
P.M. 6:30

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.



Education and Training

EDUCATION
TYPE OF SCHOOL
NAME, ADDRESS (STREET AND CITY), AND PHONE # DEGREE SELECT LAST
YEAR
ATTENDED
MAJOR
High School
10
11  12
  Date of Graduation (month/year):  
College
1   2
3   4
  Date of Graduation (month/year):  
College
1   2
3   4
  Date of Graduation (month/year):  
Graduate School
1   2
3   4
  Date of Graduation (month/year):  
Other
1   2
3   4
  Date of Graduation (month/year):  

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.


Employment History

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 employment.)

Company Name and Address:   Phone: - -
Job Title: Description of duties:

Reason for leaving:
From Month
Year
Hourly Rate/Salary
Start $ per
Final $ per
To Month
Year
May we contact this employer?  Yes  No  Later
Supervisorís Name/Title:
Company Name and Address:   Phone: - -
Job Title: Description of duties:
Reason for leaving:
From Month
Year
Hourly Rate/Salary
Start $ per
Final $ per
To Month
Year
May we contact this employer?  Yes  No  Later
Supervisorís Name/Title:
Company Name and Address:   Phone: - -
Job Title: Description of duties:
Reason for leaving:
From Month
Year
Hourly Rate/Salary
Start $ per
Final $ per
To Month
Year
May we contact this employer?  Yes  No  Later
Supervisorís Name/Title:
Company Name and Address:   Phone: - -
Job Title: Description of duties:
Reason for leaving:
From Month
Year
Hourly Rate/Salary
Start $ per
Final $ per
To Month
Year
May we contact this employer?  Yes  No  Later
Supervisorís Name/Title:
Company Name and Address:   Phone: - -
Job Title: Description of duties:
Reason for leaving:
From Month
Year
Hourly Rate/Salary
Start $ per
Final $ per
To Month
Year
May we contact this employer?  Yes  No  Later
Supervisorís Name/Title:
Company Name and Address:   Phone: - -
Job Title: Description of duties:
Reason for leaving:
From Month
Year
Hourly Rate/Salary
Start $ per
Final $ per
To Month
Year
May we contact this employer?  Yes  No  Later
Supervisorís Name/Title:

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 CONDITIONS.

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 application form.

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.

Signature of Applicant
Date

By typing my name, I confirm this statement.


Supplemental Skills


 

Name
Date

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 be considered.

3 = Extensive Skill and Experience: Have performed task extensively in a work setting. No training required.
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 performed task.


Clerical Banking
Contracts Back Counter/Image
Correspondence Loan Administration
Editing for Spelling, Grammar & Punctuation Loans
Forms Teller Machine
Reports  
Statistical Data Scheduling / Coordination
Distribute / Route / Post Mail Appointment Calendar
Fax Machine Operations Conferences / Seminars
Taking Meeting Minutes Meetings
   
Computer Software Budget Control
Microsoft Office Develop Proposal
Microsoft Exel Expense Report Preparation
Microsoft Word Monitor Expenditures
Microsoft Publisher  
PowerPoint Accounting / Bookkeeping
MS Outlook 10-Key Calculator
NT System Accounts Payable
Laser Pro Accounts Receivable
Fiserv Software Billing
Other (please specify): Cash Handling
Other (please specify): Computerized Financial Systems
Other (please specify): General Ledgers
  Payment Scheduling
Computer Tasks Payroll
Charts/Graphs Posting
Creating Macros Reconciliation
Data Entry Transfer of Funds
Graphics  
Labels Supervision
Merges Employees Ė How Many
Newsletter Evaluate Job Performance
Scanning/Indexing Interview & Select
Spreadsheets Review Work
Tables Schedule Work
Templates Take Corrective Action
Web Design Train Staff
   
Customer Service / Public Contact  
Assist Public / Customers  
Front Desk Reception  
Busy / Fast-Paced Traffic  
Slow / Moderate Traffic  
Problem Solving  
Multi-Line Telephone (4+ lines)  

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 interview.

Name
Date

By typing my name, I confirm this statement.

 


 

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.

Signature of Applicant
Date

By typing my name, I confirm this statement.


Race & Ethnicity

 

Name:
 
Position applied for:
 
Date:


The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Race/Ethnicity (Please check all that apply):

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
 
White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
 
Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
 
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
 
Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
 
American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
 

Sex

Male Female



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 bwalters@progressivebank.com.