Employment Application

Required Field

Applicant

First Name Middle Initial Last Name Maiden/Previous Name Suffix Social Security Number Birth Date Mother's Maiden Name Home Address City State Zip Code

Have you lived here for two or more years?

Yes
No

Previous Home Address City State Zip Code Daytime Phone Number Home Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted?

Home Phone
Daytime Phone
Email
Other

Referred By

Are you under 18 years of age?

Work permit needed if under 18

Yes
No

Are you fluent in any language(s) other than English

Yes
No

Job Specific Information

Position Applying For

Which branch location(s) are you applying for?

Any
Jacksboro
Huntsville
Oneida
Pine Knot
Whitley Main
Whitley North
Somerset

What is your employment preference?

Any
Full-Time
Part-Time
Peak-Time
Temporary or Seasonal employment

Desired Pay Rate Rate Per (Hour, Month, or Year) Date Available to Begin Work

What days/hours are you able to work?

Time AM
Time PM

Sunday from
to

Monday from
to

Tuesday from
to

Wednesday from
to

Thursday from
to

Friday from
to

Saturday from
to

Are you willing to work overtime if requested to do so?

Yes
No

Are you an experienced operator of any of the following? (Select all that apply)

If other please explain List any personal characteristics, skills, attitudes, or achievements which you feel would qualify you for this position.

Have you ever been convicted of a felony or misdemeanor, or do you have any charges pending against you?

A conviction or pending charge will not be an automatic bar to employment and will be considered only as it relates to the job in question.

Yes
No

If yes, please explain

Have you ever paid a civil forfeiture or fine for a non-traffic related offense?

Payment of a civil forfeiture or fine will not be an automatic bar to employment and will be considered only as it relates to the job in question.

Yes
No

If yes, please explain

Education History

High School

Name Address City State Zip Code Major

What was your last year completed?

1
2
3
4

Did you graduate?

Yes
No

Degree/Diploma

Business/Trade School

Name Address City State Zip Code Major

What was your last year completed?

1
2
3
4

Did you graduate?

Yes
No

Degree/Diploma

College

Name Address City State Zip Code Major

What was your last year completed?

1
2
3
4

Did you graduate?

Yes
No

Degree/Diploma

Graduate Studies

Name Address City State Zip Code Major

What was your last year completed?

1
2
3
4

Did you graduate?

Yes
No

Degree/Diploma

Other

Name Address City State Zip Code Major

What was your last year completed?

1
2
3
4

Did you graduate?

Yes
No

Degree/Diploma

Employment History

Have you been employed before?

Yes
No

Starting with the present or most recent, list all previous employers. Include self-employment, military service, summer and part-time jobs.

Employer

Employer Name Address City State Zip Code Last Position Held Employment Start Date Employment End Date (Today's date if current employer) Reason for Leaving Job Duties Name and Title of Supervisor Phone Number E-mail

May we contact this employer?

Yes
No

 Add Another Employer

References

List the names of persons not related to you, who know of your work or qualifications.

Reference 1

First Name Last Name Phone Number

Reference 2

First Name Last Name Phone Number

Reference 3

First Name Last Name Phone Number

Endorsement

I certify that the facts set forth in this application are true, correct and complete without misrepresentations or omissions of any kind whatsoever. I authorize investigation of the statements I have made herein. I hereby release from any and all liability all representatives of United Cumberland Bank for their acts performed in connection with evaluating my application, background, credentials and qualifications. I hereby further authorize any party (including the companies, schools and organizations listed in this application form) to release any information they may have about me to United Cumberland Bank, including all of my personnel records with prior employers. I also release all persons, companies, schools and organizations (and all persons connected with them) who provide such information to United Cumberland Bank from any and all liability for any damage for giving this information. I understand that if any of the information on this application form is discovered to be incorrect, false or misleading or if there are any misrepresentations or omissions of and kind whatsoever, then United Cumberland Bank may deny me employment or terminate my employment, and I agree that United Cumberland Bank shall not be liable in any respect if it does so. I also understand that my employment at United Cumberland Bank is contingent upon the satisfactory completion of a drug screen and an investigation of my work record and references. I consent to a pre-employment physical examination and such future examinations as may be required by United Cumberland Bank, which may include drug screening. I understand that if I am employed by United Cumberland Bank, any such employment is not binding on either party for any specific period of time. I further understand that no representative of United Cumberland Bank, other than the CEO or President, has any authority to enter into any agreement for employment for any specified period of time. Any such agreement must be in writing and signed by such officer. I understand that any other written or oral statement to the contrary, even if made by a supervisor, manager or officer of United Cumberland Bank, is invalid and should not be relied on by me. I understand that if employed I will be an employee-at-will and that either United Cumberland Bank or I may terminate that employment relationship at any time, for any reason, with or without notice.

I acknowledge that I have read and understand the Employee Application Authorization. Applicant's Signature Date