Job Application

* Indicates Required

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

  Applicant Information

  Last Name *

  First Name *

  Middle Initial

  
  

  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*

  Phone*

  Email*

  Date Available*

  Social Security Number*

  Desired Salary*

  $

  Position Applied For*

  
  

  Are you a citizen of the United States? *

  Yes No

  Whether you are a citizen of the United States is required

  If no, are you authorized to work in the U.S.? *

  Yes No

  Whether you are authorized to work in the U.S. is required

  Have you ever worked for this company? *

  Yes No

  Whether you have previously worked for this company is required

  If yes, when? *

  Are you related to anyone working at US #1364 FCU or on the board of directors? *

  Yes No

  Whether you are related to anyone working at US #1364 FCU or on the board of directors is required

  Have you ever been convicted of a felony? *

  Yes No

  Whether you have been convicted of a felony is required

  If yes, explain *

• Education

  High School *

  Address *

  Address line 2

  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*

  From *

  To *

  Degree *

  Did you graduate? *

  Yes No

  Whether you graduated is required

  College *

  Address *

  Address line 2

  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*

  From *

  To *

  Degree *

  Did you graduate? *

  Yes No

  Whether you graduated is required

  Other

  Address

  Address line 2

  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

  From

  To

  Degree

  Did you graduate?

  Yes No

• Availability

   

  From

  To

  Monday

  Available from on Monday

  Available to on Monday

  Tuesday

  Available from on Tuesday

  Available to on Tuesday

  Wednesday

  Available from on Wednesday

  Available to on Wednesday

  Thursday

  Available from on Thursday

  Available to on Thursday

  Friday

  Available from on Friday

  Available to on Friday

  Saturday

  Available from on Saturday

  Available to on Saturday

• References

  Please list three professional references.

  Reference 1

  Full Name*

  Relationship *

  Company *

  Phone *

  Address *

  Address line 2

  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 *

  Address line 2

  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 *

  Address line 2

  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*

  
  

• Previous Employment

  Previous Job 1

  Company*

  Address*

  City*

  State*

  Alabama Alaska Arizona Arkansas Cadivfornia 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 Carodivna North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carodivna South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip*

  Supervisor Name *

  Phone *

  Job Title*

  Starting Salary*

  $

  Ending Salary*

  $

  Responsibilities*

  From*

  To*

  Reason for leaving*

  May we contact your previous supervisor for a reference?*

  Yes No

  Whether we may contact your previous supervisor is required

  Have you worked at another job within the past 2 years?*

  Yes No

  Whether you have another previous employment is required

  Previous Job 2

  Company*

  Address*

  City*

  State*

  Alabama Alaska Arizona Arkansas Cadivfornia 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 Carodivna North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carodivna South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip*

  Supervisor Name *

  Phone *

  Job Title*

  Starting Salary*

  $

  Ending Salary*

  $

  Responsibilities*

  From*

  To*

  Reason for leaving*

  May we contact your previous supervisor for a reference?*

  Yes No

  Whether we may contact your previous supervisor is required

  Have you worked at another job within the past 2 years?*

  Yes No

  Whether you have another previous employment is required

  Previous Job 3

  Company*

  Address*

  City*

  State*

  Alabama Alaska Arizona Arkansas Cadivfornia 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 Carodivna North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carodivna South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip*

  Supervisor Name *

  Phone *

  Job Title*

  Starting Salary*

  $

  Ending Salary*

  $

  Responsibilities*

  From*

  To*

  Reason for leaving*

  May we contact your previous supervisor for a reference?*

  Yes No

  Whether we may contact your previous supervisor is required

• Military Service

  Have you ever served in the military? *

  Yes No

  Whether you have served in the military is required

  Branch *

  From *

  To *

  Rank at Discharge*

  Type of Discharge*

  If other than honorable, please explain

• Disclaimer and Signature

  I certify that my answers are true and complete to the best of my knowledge.

  If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

  Signature*

  Date*