Application Commercial Bank of Grayson

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All qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, national origin, disability, veteran status, genetic data or other legally protected status. Commercial Bank of Grayson is an Equal Opportunity Employer of women, minorities, protected veterans and individuals with disabilities. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization.

EEO IS THE LAW

PERSONAL INFORMATION

Name(Required)

First Last

Date

Phone

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Best Time to Call You

Are you currently eligible to work in the U.S.?

Yes

Are you 18 or older?

Yes

(If no, employment is subject to verification that you are of minimum legal age.)

REFERRAL SOURCE: Please check appropriate category:

Walk In

School

Website

Government Employment Agency

Employee:

Other

Employee Name

Other Way:

EMPLOYMENT INFORMATION

Position applying for

Type of employment desired:

Full Time

Part Time

Temporary

Date Available for Work

Desired Salary Range or Rate of Pay

What days and hours are you available to work?

Days

Hours

Will you work overtime if required?

Yes

If no, please explain:

Have you applied for a job with us before?

Yes

When?

Have you ever held a position of trust (handling money or confidential material)?

Yes

Have you ever pled “guilty” or “no contest” to or been convicted of a crime?

Yes

If yes, provide date and details:

Have you ever been discharged or asked to resign?

Yes

Have you ever been bonded?

Yes

Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation:

Yes

PRIOR WORK RECORD (start with most recent or present employer. Section must be completed in its entirety even if accompanied by resume.)

May we contact the employers listed below

Yes

1) Name & Address of Most Recent Employer

Telephone No.

Immediate Supervisor (Name & Position)

Telephone No.

Date Hired

Starting Pay Rate

Your Job Title & Duties

Date Left

Last Pay Rate

Reason for Leaving

What did you like most about job:

What did you like least about job:

2) Name & Address of Most Recent Employer

Telephone No.

Immediate Supervisor (Name & Position)

Date Hired

Starting Pay Rate

Your Job Title & Duties

Date Left

Last Pay Rate

Reason for Leaving

What did you like most about job:

What did you like least about job:

3) Name & Address of Most Recent Employer

Starting Pay Rate

Date Hired

Your Job Title & Duties

Date Left

Last Pay Rate

Reason for Leaving

What did you like most about job:

What did you like least about job:

EDUCATION INFORMATION

SCHOOL

LOCATION

YEARS COMPLETED

DIPLOMA OR DEGREE

MAJOR & MINOR

Please fill in all that apply in order. HIGH SCHOOL/ TRADE BUSINESS, or CORRESPONDENCE/ COLLEGE/ Graduate School

Are there any experiences, skills, or qualifications you have that specifically relate to working here?

Describe any other specialized or professional training (such as business or technical school). Include study courses given through public or private employment. State whether degree or certificate was received

REFERENCES

NAME

TITLE

RELATIONSHIP TO YOU

TELEPHONE

EMAIL ADDRESS

# YEARS KNOWN

(Do not list relatives or former employers)

APPLICANT STATEMENT The facts set forth above in my application for employment are true and complete. I understand that if employed, false statements or omission of information on this application, a resume, or other applicant information provided may be considered sufficient reason for dismissal. I understand that consumer reports which may contain public record information may be requested from the reporting agency. These reports may include information as to my character, work habits, performance, and experiences along with reasons for termination of past employment from previous employers. Further, I understand that you may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences. understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigative consumer report. I authorize the use of my information in this application to verify my statements, and I authorize the past employers, all references and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information. I understand that employment with The Commercial Bank of Grayson is on an “at will” basis, and includes no guarantee, contract, or promise of employment for any specific length of time. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant(Required)

Date(Required)

Consent(Required)

I agree to the privacy policy.

Affirmative Action: Voluntary Self Identification Form

We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, military/veteran status, or any other protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria. As required by law, we must record certain information to be made a part of our Affirmative Action Program. To comply with requirements regarding government recordkeeping, reporting and other legal obligations that may apply, we ask you to complete this Voluntary Self-Identification Form. Providing this information is VOLUNTARY. This information will be used only in our Affirmative Action Program. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. The information will be used and kept confidential in accordance with applicable laws and regulations. This survey is not part of your official application for employment. Please complete the information requested below. Thank you for your cooperation.

Position applied for:

Referral Source:

Walk In

Government Employment Agency

Third Choice

Employee

Website

Relative

Other

Elaborate

Name of person who referred you (if applicable)

General Applicant Information:

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Date

Gender

Male

Female

EEO SELF-IDENTIFICATION Please check the box that applies to you:

Hispanic or Latino

White

Black or African American (Not Hispanic or Latino)

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

Asian (Not Hispanic or Latino)

American Indian or Alaska Native (Not Hispanic or Latino)

Two or More Races (Not Hispanic or Latino)

Please check all boxes that apply to you:

Armed Forces Service Medal Veteran

I am an Armed Forces Service Medal Veteran

Includes any veteran who, while serving on active duty in the Armed Forces, participated in a United States military operation for which a service medal was awarded pursuant to Executive Order 12985.

Veteran of the Vietnam-Era:

I am a Veteran of the Vietnam-Era

Means a person who: (i) served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; or (ii) was discharged or released from active duty in the U.S. military, ground, naval or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in any other location.

Special Disabled Veteran:

I am a Special Disabled Veteran

Means (i) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service connected disability.

Other Protected Veteran:

I am a Other Protected Veteran

Includes any veteran who served on active duty in the U.S. military, ground, navel or air service in a war, campaign or expedition in which a campaign badge has been authorized under laws administered by the Department of Defense.

Recently Separated Veteran

I am a Recently Separated Veteran

Any veteran who served on active duty in the U.S. military, ground, naval or air service during the one year period beginning on the date of such veteran’s discharge or release from active duty.

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Application for Employment

Application for Employment

PERSONAL INFORMATION

EMPLOYMENT INFORMATION

PRIOR WORK RECORD (start with most recent or present employer. Section must be completed in its entirety even if accompanied by resume.)

Affirmative Action: Voluntary Self Identification Form