Application for Employment ... - Rochester NY Banking

Application for Employment

PLEASE PRINT

ADVANTAGE FEDERAL CREDIT UNION 1975 BUFFALO ROAD ROCHESTER, NY 14624

Position(s) Applied For:

Date

Name Last

First

Middle

Address

Street

City

State

Zip

Telephone

If you are under 18, can you furnish a work permit?

YES

NO

Have you ever been employed here before?

YES

NO

Are you legally eligible for employment in this country?

YES

NO

(you will be required to furnish proof of lawful work status if you are extended a job offer)

Date available for work:

Required salary range:

Type of employment desired: Are you able to meet the attendance requirement of the position? Have you been convicted of a crime? If yes, please describe fully the nature of the offense:

FULL TIME YES YES

PART TIME NO NO

EMPLOYMENT HISTORY

List your last three (3) employers, assignment or volunteer activities, starting with the most recent, including military experience.

From

To

Employer

Telephone

Job Title

Address

Immediate Supervisor & Title Summarize the nature of work performed and job responsibilities

Reason for leaving

From

To

Job Title

Immediate Supervisor & Title

Hourly Rate/Salary Start $________per_____ Final $________per_____ Employer

Address

Summarize the nature of work performed and job responsibilities

Telephone

Reason for leaving

From

To

Job Title Immediate Supervisor & Title

Hourly Rate/Salary

Start $________per_____ Final $________per_____

Employer Address Summarize the nature of work performed and job responsibilities

Telephone

Reason for leaving

Hourly Rate/Salary Start $________per_____ Final $________per_____

May we contact your present employer at this time?

YES

NO

Application for Employment

ADVANTAGE FEDERAL CREDIT UNION 1975 BUFFALO ROAD ROCHESTER, NY 14624

Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our company.

Educational Background Name and Location

High School College Other

Years Completed

Did You Graduate Course of Study

References

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

Name

Years Known

Telephone

I understand that if I am hired, my employment may be terminated with or without cause or notice, at any time, at either my option or that of AFCU. I understand that no management representative has any authority to enter into any agreement for continuing employment for any specific period of time or which is contrary to the foregoing and that any such agreement must be in writing signed by the Company President. I give AFCU permission to contact all or any of my previous employers and references and authorize them to disclose any information AFCU may request in the course of its investigation of this application for employment, and I hereby release AFCU and such references and prior employers from any and all liability with respect to such disclosures. I understand that any offer of employment is conditioned upon receipt of satisfactory references.

I have provided truthful and complete responses to all inquiries in the application and authorize AFCU to investigate all statements contained in the application. I understand than the discovery of any falsification or omission constitutes a ground for immediate dismissal or refusal to hire. If employed, I will abide by AFCU's rules and regulations, which I understand are subject to change by AFCU.

Signature

Date

We appreciate your interest in Advantage Federal Credit Union. AFCU offers equal opportunities to all persons without regard to race, color, religion, age, sex, disability, national origin, citizenship, military status, marital status, sexual orientation, domestic violence victim status, predisposing genetic characteristics and genetic information, and any other status protected by law.

Rev: 2/2015

AN EQUAL OPPORTUNITY EMPLOYER

Disclosure

It is the policy of the credit union to protect the safety and soundness of the credit union and the interests of its members by obtaining a consumer report and / or an investigative consumer report on certain applicants and employees. This release shall serve as a formal disclosure that a consumer report may be obtained.

The credit union will not use the information obtained in violation of any federal or state equal opportunity law or regulation, and that, if any adverse action is to be taken based on the consumer report, a copy of the report and a summary of the consumer's rights will be provided to the applicant/employee.

Should an investigative consumer report be completed, the applicant/employee may request (in writing) a complete description of the nature and scope of the investigation.

Release

I authorize any consumer reporting agency to furnish to the credit union, or any agent acting on its behalf, a consumer report and/or an investigative consumer report including information as to my character, general reputation and personal characteristics.

I recognize that I may be subject to a consumer report and/or and investigative consumer report ordered by the credit union, and that I have a right to request in writing whether or not a consumer report and/or investigative consumer report was requested and if either report was requested, the name and address of the consumer report was requested and if either report was requested the name and address of the consumer reporting agency to whom the request was made and in the case of an investigative consumer report, a complete and accurate disclosure of the nature and scope of the investigation requested.

______________________________ Social Security Number

______________________________ Signature of applicant/employee

__________________ Date

Rev: 9/2011

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