Employment Application

Personal Information

  • OK First Name is required
  • OK Middle Name or Initial is required
  • OK Last Name is required

  • Social Security Number

    - -
    OK Social Security Number is required

  • Are you over 18 years of age?

    OK is required
  • OK Address is required
  • OK City is required
  • OK State is required
  • OK Zip Code is required
  • Optional OK Phone is required
  • OK Cell Phone is required
  • OK E-mail is required

Employment Desired

  • OK Position Applying For is required

  • Are you applying for a Teller position?

    OK Are you applying for a Teller position? is required

  • Are you available to work any hours between 7:00 a.m. and 6:15 p.m. Mon.‐Fri.?

    OK Are you available to work any hours between 7:00 a.m. and 6:15 p.m. Mon.‐Fri.? is required

  • Are you available to work Saturdays?

    OK Are you available to work Saturdays? is required

  • Full-time or Part-time?

    OK Full-time or Part-time? is required
  • OK Please type your name here to confirm compliance with teller availability. is required
  • Optional OK Referred by is required
  • Optional OK List any friends or relatives working here, and their relationship to you is required
    Optional OK N/A is required
  • OK Date Available to Start is required
  • Optional OK List any days/hours you are unable to work is required
    Optional OK N/A is required
  • OK Wage Desired is required

  • Are you employed now?

    OK Are you employed now? is required

  • If so, may we inquire of your present employer?

    OK If so, may we inquire of your present employer? is required

  • Have you ever worked for us before?

    OK Have you ever worked for us before? is required
  • OK If Yes, when and where? is required
  • OK Reason for Leaving is required
  • OK Name of Last Supervisor at this company: is required
  • Optional OK What type of experience do you have which would be helpful for the job you are applying for? is required
    Optional OK N/A is required

  • How did you find out about this position?

    OK How did you find out about this position? is required
  • OK If other, please specify: is required

United States Military

  • Do you have any U.S. Military experience?

    OK Do you have any U.S. Military experience? is required
  • OK Date Entered is required
  • OK Date Discharged is required
  • OK Rank at time of discharge is required
  • OK Present Military status is required
  • OK Special skills or training from service is required

Education

  • OK High School is required
  • OK Years Completed is required
  • OK Degree Earned/Major is required
  • Optional OK College is required
  • OK Years Completed is required
  • OK Degree Earned/Major is required
  • Optional OK Other is required
  • OK Years Completed is required
  • OK Degree Earned/Major is required
  • Optional OK Subject of Special Study/Research Work is required
  • Optional OK Special training, certifications, licenses is required
  • Optional OK Special skills, foreign languages, etc. is required

Work Experience

  • OK Company Name is required
  • OK Hire Date is required
  • Optional OK Termination Date is required
    Optional OK N/A is required
  • OK Address is required
  • OK Phone is required
  • OK Position is required
  • OK Supervisor Name & Title is required
  • OK Reason for Leaving is required
  • Optional OK Company Name is required
  • OK Hire Date is required
  • Optional OK Termination Date is required
    Optional OK N/A is required
  • OK Address is required
  • OK Phone is required
  • OK Position is required
  • OK Supervisor Name & Title is required
  • OK Reason for Leaving is required
  • Optional OK Company Name is required
  • OK Hire Date is required
  • Optional OK Termination Date is required
    Optional OK N/A is required
  • OK Address is required
  • OK Phone is required
  • OK Position is required
  • OK Supervisor Name & Title is required
  • OK Reason for Leaving is required

Professional References

  • OK Name is required
  • OK Address is required
  • OK Business is required
  • OK Phone is required
  • OK Name is required
  • OK Address is required
  • OK Business is required
  • OK Phone is required
  • Optional OK Name is required
  • Optional OK Address is required
  • Optional OK Business is required
  • Optional OK Phone is required

Special Purpose Questions

  • Have you been convicted of a felony in the last five years?

    OK Have you been convicted of a felony in the last five years? is required
  • OK If Yes, please explain is required

AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION

  • OK

    Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state, and local laws, I hereby authorize and permit First State Bank to obtain a consumer report and/or an investigative consumer report which may include the following:

    1. My employment records;
    2. Records concerning any driving, criminal history, credit history, civil record, worker's compensation (post‐offer only) and drug test;
    3. Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service records.

    I understand that an "investigative consumer report" may include information as to my character, general reputation, personal characteristics, and mode of living, which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information.

    I agree that a copy of this authorization has the same effect as an original.

    I hereby release and hold harmless any person, firm or entity that . discloses matters in accordance with this authorization, as well as from liability that might otherwise result from the request for use of and/or provided proper identification.

    I understand and acknowledge that under provisions of the Fair Credit Reporting Act that I may request a copy of any consumer report from the consumer reporting agency that compiled the report, after I have provided proper identification.

    I hereby authorize First State Bank to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my employment application. This authorization shall remain in effect over the course of my employment. Reports may be ordered periodically during the course of my employment.

    Please type your name below to signify your compliance.

    is required

Submit

  • OK Security Code is required

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