Employment Application

Applicant Information

Incomplete information could disqualify you from further consideration. Please complete all fields.

• First Name*
• Last Name*
• Street Address*
• Apartment/Unit
• City*
• State*
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip*
• Email Address*
• Home Phone #*
• Mobile Phone #*
• Are you eligible to work in the US? *

  Yes No

  Are you eligible to work in the US? is required
• Are you 18 or older? *

  Yes No

  Are you 18 or older? is required
• Have you ever been terminated from employment or asked to resign by an employer? *

  Yes No

  Have you ever been terminated from employment or asked to resign by an employer? is required
• Company Name *
  Details *
• Can you work any shift? *

  Yes No

  Can you work any shift? is required
• Details *
  Shift preferred *

  1 2 3 Any

  Shift preferred is required
• Can you work overtime, including weekends? *

  Yes No

  Can you work overtime, including weekends? is required
• Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)?*

  Yes No Need more information about the job's essential functions to respond.

  Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)? is required

  This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Employment Desired

• On what date would you be available for work? *
• Hourly rate/Salary Desired*
• Position Desired *
• Are you currently employed? *

  Yes No

  Are you currently employed? is required
• May we inquire of your present employer? *

  Yes No

  May we inquire of your present employer? is required

Referral Source

• How did you hear about us? *

  Walk In Advertisement Referral Other

  How did you hear about us? is required
• Have you ever worked for this company before? *

  Yes No

  Have you ever worked for this company before? is required

  Explain *
• Do you know anyone who works for our company? *

  Yes No

  Do you know anyone who works for our company? is required
  Who? *

Education

• High School
• Completed

  Diploma GED Other

  Completed is required

• College or University
• Address
• Completed

  Diploma Degree Certification GED Other

  Completed is required
• Degree
  
  
• Certification
  
  
• Other
  
  
• Major/Minor

• Trade, Business or Correspondence School
• Address
• Completed

  Diploma Degree Certification GED Other

  Completed is required
• Degree
  
  
• Certification
  
  
• Other
  
  
• Major/Minor

Employment History

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

References

Give the names of three persons not related to you, whom you have known at least three (3) years.

Reference 1

• Full Name*
• Relationship *
• Company: *
• Phone*
• Address*
• City*
• State*
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip*

Reference 2

• Full Name*
• Relationship *
• Company: *
• Phone*
• Address*
• City*
• State*
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip*

Reference 3

• Full Name*
• Relationship *
• Company: *
• Phone*
• Address*
• City*
• State*
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip*

Agreement

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Bank of Pontiac to hire me. If I am hired, I understand that either Bank of Pontiac or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Bank of Pontiac has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Bank of Pontiac true and complete information on this application. No requested information has been concealed. I authorize Bank of Pontiac to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

• I agree with the above terms, and that by checking this box am considered to have provided my legally binding signature.*
  Your agreement to the terms is required.
• Date*