SOUTHERN LAKES CREDIT UNION
EMPLOYMENT APPLICATION

We consider applicants for all positions without regard to race, 
color, religion, creed, gender, national origin, age, disability, 
marital or veteran status, sexual orientation, or any other legally protected status.
How did you learn about us? Website  Advertisement  Friend  Employment Agency   Relative  Other

Personal Information

Position Applying For:

Last Name:

First Name:

Middle Name:

Address:

City:

State:

 Zip:

Home Phone:

 example: 1234567890

Work Phone:

 example: 1234567890

Social Security:

 example: 123456789

Email Address:

Yes  No

 If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes  No Have you ever filed an application with us before?

If yes, give date
Yes  No Have you ever been employed with us before?

If yes, give date
Yes  No Are you currently employed?
Yes  No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.

On what date would you be available for work?
Yes  No Are you currently in "layoff" status and subject to recall?
Yes  No Can you travel if a job requires it?
Yes  No Have you been convicted of a felony within the last 7 years? 
Conviction will not necessarily disqualify an applicant from employment.

Education

Name & Address Course of Study Years Completed

Elementary School

High School

Undergraduate College

Graduate Professional

Other (Specify)

Indicate any foreign languages that you can speak, read, or write.

Describe any specialized training, apprenticeship, and skills.

Describe any job related training received in the US military.

Summarize special job-related skills and qualifications acquired from employment or other experience.

CRT 
PC
Calculator
Typewriter
Fax
Windows
Word
Excel

 Production/Machinery: 

Other:

Skills and
Additional Information

Employment History

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

Employment:

Address:

Job Title:

Supervisor:
Dates Employed: From To    
Hourly Rate/Salary:
Reason for Leaving:
Work Performed:
   

Employment:

Address:

Job Title:

Supervisor:
Dates Employed: From To    
Hourly Rate/Salary:
Reason for Leaving:
Work Performed:
   

Employment:

Address:

Job Title:

Supervisor:
Dates Employed: From To    
Hourly Rate/Salary:
Reason for Leaving:
Work Performed:
List professional, trade, business, or civic activities and offices held.

References
List references name, address and phone numbers.

Yes  No Applicants statement

Note to applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner the activities involved in the job or occupation for which you have applied? A description of the activities involved in such a job or occupation is attached.

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. 
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined be applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employment.

Accept 

Disagree 

Disclosure of request for consumer investigative reports

This is to inform you that as part of our procedure for processing your employment application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with your neighbors, friends, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, and mode of living. You 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 investigation.

Accept 

Disagree 

Authorization for release of information

I authorize my former/current employers to furnish Southern Lakes Credit Union with whatever information they may have regarding my employment, including my reason(s) for leaving. I am signing this authorization voluntarily, and request that my former/current employers respond to this reference with full and complete information. Since this reference is an important part of my application for employment with Southern Lakes Credit Union, I therefore waive and release my former/current employers from any and all claims or causes of action in law or equity, including but not limited to, defamation of character or invasion of privacy, which might arise from responding to this reference check.

Accept 

Disagree