Employment Application

Full Name (First, Middle, Last)

General General -

SSN

Email Address

Cell Phone #

Full Address

Additional Phone #

Date of Birth

Are You 18 Or Older? Are You 18 Or Older? Yes No

If Hired, Can You Provide Proof Of Citizenship Or Legal Right To Work In The United States? If Hired, Can You Provide Proof Of Citizenship Or Legal Right To Work In The United States? Yes No

Have You Ever Plead Guilty (Including Deferred Adjudication) Or Been Convicted Of Any Criminal Offense, Other Than Minor Traffic Citations? If Yes, Please Explain Below. Have You Ever Plead Guilty (Including Deferred Adjudication) Or Been Convicted Of Any Criminal Offense, Other Than Minor Traffic Citations? If Yes, Please Explain Below. Yes No

Please Explain

Position Position -

Position Applied For? Position Applied For? Teller Manager Other

If other, please identify the position that you are applying for.

Source Of Referral

Availability Date

Desired Position Type Desired Position Type Full Time Part Time

Expected Salary

Do You Have Any Limitations On Your Availability? Do You Have Any Limitations On Your Availability? Yes No

Please Explain

Employment History Employment History -

Employer 1: Business Name

Employer 1: Start & End Date

Employer 1: Supervisor Name

Employer 1: Phone Number

Employer 1: City/State

Employer 1: Reason For Leaving

Employer 2: Business Name

Employer 2: Start & End Date

Employer 2: Supervisor Name

Employer 2: Phone Number

Employer 2: City/State

Employer 2: Reason For Leaving

Employer 3: Business Name

Employer 3: Start & End Date

Employer 3: Supervisor Name

Employer 3: Phone Number

Employer 3: City/State

Employer 3: Reason For Leaving

Employer 4: Business Name

Employer 4: Start & End Date

Employer 4: Supervisor Name

Employer 4: Phone Number

Employer 4: City/State

Employer 4: Reason For Leaving

Please List Any Other Work Experience That Would Be Relevant To This Position And Explain Any Gaps In Work History

Education And Training Education And Training -

Graduated High School? Graduated High School? Yes No

School Name And Address

Graduated University Or Technical School? Graduated University Or Technical School? Yes No

University Name And Address

Do You Have A Valid Driver's License? Do You Have A Valid Driver's License? Yes No

What state is your driver's license registered in?

What is your driver's license number?

Are You Bilingual? Are You Bilingual? Yes No

What language(s) do you speak?

Do You Have Computer Software Skills? Do You Have Computer Software Skills? Yes No

Explain

Do You Have Any Office Machinery Skills? Do You Have Any Office Machinery Skills? Yes No

Explain

Do You Have Any Cash Handling Skills? Do You Have Any Cash Handling Skills? Yes No

How Many Months Of Cash Handling?

Any Other Skills You Would Like To Mention

References References -

Reference #1 Name

Relationship

Cell Phone #

Reference #2 Name

Relationship

Cell Phone #

Authorization Authorization -

I HEREBY AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU. I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR TERMINATION. I UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINED TIME PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE. NO PERSON SHALL BE DENIED EMPLOYMENT ON THE BASIS OF RACE, COLOR, ETHNICITY, NATIONAL ORIGIN, SEX/GENDER, SEXUAL ORIENTATION, RELIGION, CREED OR DISABILITY EMPLOYMENT IS CONTINGENT UPON FURNISHING EVIDENCE OF IDENTITY AND EMPLOYMENT ELIGIBILITY.

Please Type Your Name Here After Reading The Statement Above