Job Application


Req #
Date submitted
Position applying for
Community location applying for
 

Applicant

First name
Middle initital
Last name
Address (Line 1)
Address (Line 2)
City
State, zip code
Home phone number
Cell phone number
Best number to contact you             Best time  
E-mail address


Desired Employment/Availability

Do you have any banking experience?
Are you related to anyone employed
by Liberty Bank?
 
If yes, who?
(Notice: Liberty Bank has a strict Nepotism Policy)
 
If you are under 18 and it is required can
you furnish a work permit?
Have you ever been employed by Liberty Bank?
If yes, give date(s) and position
Have you ever applied with Liberty Bank before?
Have you ever been bonded?
If yes, give dates  to 
Are you legally eligible for employment in this
country?
Will you travel if job requires it?
Will you relocate if job requires?
Will you work overtime if required?
Desired annual salary range or hourly
rate of pay?
$  per 
 
How did you hear about a position with
Liberty Bank?
Number of hours desired per week
Hours of Availability
Monday:   
Tuesday:   
Wednesday:   
Thursday:   
Friday:   
Saturday:   
Sunday:   
Date available to begin work


Employment History

Starting with your most recent employer, provide the following information

Most Recent Employer

Employer
Telephone
Address
City, State
Dates Employed  to 
Starting job title / final job title  / 
Starting Compensation
Ending Compensation
Immediate supervisor and title
(for most recent position held)
Summarize the type of work you performed and job responsibilities
What did you like most about your job?
What did you like least about your job?
Why did you leave?
May we contact this employer for a reference?
If no, why?

Employer 2

Employer
Telephone
Address
City, State
Dates Employed  to 
Starting job title / final job title  / 
Starting Compensation
Ending Compensation
Immediate supervisor and title
(for most recent position held)
Summarize the type of work you performed and job responsibilities
What did you like most about your job?
What did you like least about your job?
Why did you leave?
May we contact this employer for a reference?
If no, why?

Employer 3

Employer
Telephone
Address
City, State
Dates Employed  to 
Starting job title / final job title  / 
Starting Compensation
Ending Compensation
Immediate supervisor and title
(for most recent position held)
Summarize the type of work you performed and job responsibilities
What did you like most about your job?
What did you like least about your job?
Why did you leave?
May we contact this employer for a reference?
If no, why?

Employer 4

Employer
Telephone
Address
City, State
Dates Employed  to 
Starting job title / final job title  / 
Starting Compensation
Ending Compensation
Immediate supervisor and title
(for most recent position held)
Summarize the type of work you performed and job responsibilities
What did you like most about your job?
What did you like least about your job?
Why did you leave?
May we contact this employer for a reference?
If no, why?

Employer 5

Employer
Telephone
Address
City, State
Dates Employed  to 
Starting job title / final job title  / 
Starting Compensation
Ending Compensation
Immediate supervisor and title
(for most recent position held)
Summarize the type of work you performed and job responsibilities
What did you like most about your job?
What did you like least about your job?
Why did you leave?
May we contact this employer for a reference?
If no, why?


Please explain any gaps in your employment, other than those due to personal illness, injury or disability

If not addressed on previous page, have you ever been fired or asked to resign from a job? 

If yes, please explain



Qualifications / Skills

Summarize any special training, skill, licenses and / or certificates that may assist you in performing the job functions for the position for which you are applying

Summarize any computer skills you have (Word Processing, Spreadsheets, Presentation software, Programming, etc.)

Is there any other job related information you would like us to know about?



Educational Background

Starting with the most recent school you have attended, provide the following information

Most Recent School

School Name
City, State
Years Completed
Major / Minor (if applicable)  / 
GPA / Class Rank (if applicable)  / 
Degree, Diploma, GED, Certification, or other

School 2

School Name
City, State
Years Completed
Major / Minor (if applicable)  / 
GPA / Class Rank (if applicable)  / 
Degree, Diploma, GED, Certification, or other

School 3

School Name
City, State
Years Completed
Major / Minor (if applicable)  / 
GPA / Class Rank (if applicable)  / 
Degree, Diploma, GED, Certification, or other

School 4

School Name
City, State
Years Completed
Major / Minor (if applicable)  / 
GPA / Class Rank (if applicable)  / 
Degree, Diploma, GED, Certification, or other


References

List name and telephone number of three business / work references who are not related to you. If not applicable, list three school or personal references who are not related to you

First Reference

Name
Title
Relationship
Phone number
Years Known

Second Reference

Name
Title
Relationship
Phone number
Years Known

Third Reference

Name
Title
Relationship
Phone number
Years Known

Fourth Reference

Name
Title
Relationship
Phone number
Years Known

Application Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I understand that any false information (or omissions) in this application, or its supporting documents, will be grounds for refusal to hire or termination without notice.

I authorize Liberty Bank, representatives of, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for supplying such information about me.

I understand that Liberty Bank does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that Liberty Bank will perform Background and Credit checks of which must be satisfactory to be employed by Liberty Bank.

If hired, I understand that any employment relationship with Liberty Bank is of an “at will” nature, which means I may resign at any time and Liberty Bank may discharge me at any time with or without cause. This application does not constitute an agreement or contract for employment for any specified period or definite duration. Supervisors / Representatives of Liberty Bank are not authorized to make any assurances to the contrary and no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the Bank President.

I also understand, if hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard on the first day of work.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.