Application for Employment | State Bank of Bement

We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

Applicant name

Position(s) applied for or type of work desired

Address

Telephone #

Type of employment desired

Date you will be available to start work

Are you able to meet the attendance requirements?

Do you have any objection to working overtime if necessary?

Can you travel if required by this position?

If you are under 18, can you furnish a work permit if it is required?

Have you have been convicted of a crime in the last 7 years?

If yes, please explain (a conviction will not automatically bar employment)

How were you referred to us?

Employment History

Employer

Position held

Address

Telephone #

Immediate supervisor and title

Date employed from / to

Job summary

Reason for leaving

Employer

Position held

Address

Telephone #

Immediate supervisor and title

Date employed from / to

Job summary

Reason for leaving

Employer

Position held

Address

Telephone #

Immediate supervisor and title

Date employed from / to

Job summary

Reason for leaving

Employer

Position held

Address

Telephone #

Immediate supervisor and title

Date employed from / to

Job summary

Reason for leaving

Other Skills and Qualifications

Other Skills and Qualifications Text

Education History

High school

College

Technical Training

Other

References

Reference 1

Reference 2

Reference 3

Credit Report Disclosure & Authorization Form

In processing your application for employment, or if you are offered employment, at any time during your employment, State Bank of Bement may obtain a consumer credit report from a consumer reporting agency for employment purposes concerning credit worthiness, credit standing and credit capacity.

Upon receiving the copy of your credit report, if you want to dispute the accuracy or completeness of any item in it, you may contact the consumer reporting agency, whose address and telephone number are included in the report and request an investigation. (A summary of your rights under the Fair Credit Reporting Act can be viewed here. If you disagree with the accuracy of any information in the report, you must notify State Bank of Bement within two days of the receipt of the report that you are challenging information in the report. State Bank of Bement will not make a final decision on your employment status until you have had a reasonable opportunity to address the information contained in the report.

Note that if you are denied employment or an adverse employment action is taken based on information obtained in the credit report, you will be notified and provided with a copy of the report as well as a written description of your rights under the Fair Credit Reporting Act.

Please read this form carefully before signing and dating it below, which will authorize State Bank of Bement to obtain a consumer credit report on you as part of the pre-employment background screening process or, if you are offered employment, for employment purposes at any time during your employment.

I consent to this investigation and hereby authorize State Bank of Bement to obtain a consumer credit report on my background for employment purposes only and acknowledge that I have been provided with a summary of my rights under the Fair Credit Reporting Act.

Would like to receive a free copy of your credit report.

I agree to the above

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

I agree to the above