Name:
Date

 

Office Use Only Date
Application #  

Application For Employment


Employment Information

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.

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.


Voluntary Applicant Data Record

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.

Name
Please Specify Your Sex
Check one
Please Specify Your Race
Check all that apply
Male
Female
I choose not to disclose
White
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
American Indian or Alaskan Native
OR
I choose not to disclose
Hispanic or Latino
Check one
No
Yes
I choose not to disclose

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

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.

How do I know if I have a disability?

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 condition.

Disabilities include, but are not limited to:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)

Please check one of the boxes below:

YES, I HAVE A DISABILITY (or previously had a disability)
NO, I DON'T HAVE A DISABILITY
I DON'T WISH TO ANSWER

Your Name

Today's Date

Reasonable Accommodation Notice

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.


POST-OFFER INVITATION TO SELF-IDENTIFY AS A VETERAN

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:

  • A "disabled veteran" is one of the following:
    • a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
    • a person who was discharged or released from active duty because of a serviceconnected disability.
  • A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteranís discharge or release from active duty in the U.S. military, ground, naval, or air service.
  • An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
  • An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

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.

Name: Date:

I BELONG TO THE FOLLOWING CLASSIFICATIONS OF PROTECTED VETERANS (CHOOSE ALL THAT APPLY):

DISABLED VETERAN
RECENTLY SEPARATED VETERAN, SEPARATION DATE:
ACTIVE WARTIME OR CAMPAIGN BADGE VETERAN
ARMED FORCES SERVICE MEDAL VETERAN
I am a protected veteran, but I choose not to self-identify the classifications to which I belong.
I am NOT a protected veteran.

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 bwalters@progressivebank.com.