Careers: Application


General Information

Date:       Phone:       SSN:  
Name:
Address:
* 200 characters max
City:       State:       Zip:  
Position Applied For:
Avalability:
Anticipated Salary Range: 
Date Available:
Referral Source:

If Agency or Other please include more detail:

* 200 characters max

 

Educational Data

High School:
 Name & Address of School:


Course of Study:


Last Year Completed:


Did You Graduate:


List Diploma or Degree:
College:
 Name & Address of School:


Course of Study:


Last Year Completed:


Did You Graduate:


List Diploma or Degree:
Graduate:
Are you currently involved in an educational program?:
   Program:

 

Personal Information

Are you under 18 years of age?........................................................
Have you ever worked under or used another name?
If so, provide name:

Have you ever plead guilty to, been convicted of, been released without imposition or sentence, or received pretrial diversion for any crime excluding minor traffic tickets? ...........................

If yes, describe all of these actions, including nature of criminal offense(s), the location(s) dates and their disposition:
* 200 characters max

 

Employment History

Have you ever been employed here?...............................................................

If yes, list date of employment, department, position held, name, and reason for leaving:

Date of Employment:      To:  
Department:
Position Held:
Under what name?
Reason for leaving:
If presently employed, why do you wish to change jobs?
* 200 characters max
If presently unemployed, give last day worked:  
Have you ever been discharged or asked to resign by any employer?...............

If yes, please explain:

 

Work History



Current/Most Recent Job
Job Title:
From:     To:     Current/Final Salary:
Employer Name:
Address:
Phone:

May we contact your current employer?..........

Immediate Supervisor:
Duties:
Reason for Leaving:


Job2
Job Title:
From:     To:     Current/Final Salary:
Employer Name:
Address:
Phone:
Immediate Supervisor:
Duties:
Reason for Leaving:


Job3
Job Title:
From:     To:     Current/Final Salary:
Employer Name:
Address:
Phone:
Immediate Supervisor:
Duties:
Reason for Leaving:


 
Please explain any gaps in your employment history: Briefly describe any banking background:

* 200 characters max
From:
To:

* 200 characters max
From:
To:

* 200 characters max

 

Special Skills

Work Skills
        

Other Skills

Please list relevant skills:

* 200 characters max
Computer Skills

 

References

Business associates who are not related to you and have firsthand knowledge of your character, experience, and capabilities.
1) Name:


Position:


Company Name:


Address:

* 200 characters max

Telephone:

 2) Name:


Position:


Company Name:


Address:

* 200 characters max

Telephone:

 3) Name:


Position:


Company Name:


Address:

* 200 characters max

Telephone:

 

I hereby certify that the information contained in this application form is true and correct. Any offer of employment by Country Club Bank is subject to a complete background check whick can include but is not limited to a credit report; criminal background check, and employment verification. By signing below, I authorize Country Club Bank to run the detailed background check. I understand that the position for which I am applying requires reliable attendance and dependable performance during contemplated work hours. If employed, I agree to comply with all of the Country Club Bank policies, rules and procedures as modified from time to time.

Are you subject to any agreement or restrictions, written or otherwise, which might restrict your ability to call on potential or existing clients of the Bank (e .g ., noncompetition or nonsolicitation agreement)?



If yes, please provide the details of the agreement below:

* 200 characters max

By selecting agree, I acknowledge that I have read and agree to the terms above.   I agree :

Country Club Bank is an equal opportunity employer. It is the policy of the Bank not to discriminate on basis of race, color, national origin, sex, age religion, or disability. The bank complies with reasonable accommodation requirements of applicable federal and state laws and prohibits harassment in the workplace. Country Club Bank is a smoke/drug/alcohol free workplace.

 

 

VOLUNTARY SELF - IDENTIFICATION (CONFIDENTIAL - STATISTICAL USE ONLY)

It is the policy of Country Club Bank, n.a. to provide employment, training, compensation, transfer or
promotion opportunities and all other aspects of employment without regard to race, gender, color, religion,
national origin, age, qualified handicapped individuals, disabled veterans, Vietnam era veterans, or other
eligible veterans.

At Country Club Bank, all terms and conditions of employment are and will continue to be established on the
basis of the individual's qualifications and ability to perform the job.

Providing the information that is requested in this form is voluntary and will assist in maintaining affirmative
actions programs and other reporting requirements. Disclosure or refusal to provide such information will
in no way result in adverse treatment. All information will be kept confidential and will be used only in ways
consistent with federal reporting requirements. Government officials engagedDisabilities Act and law regulating government contractors may be informed.

Date of Birth:   Gender:  
Ethnic Group:  
Please check one of the descriptions below corresponding to the ethnic group with which you most identify.

Veteran Status:
(Please check one if it describes your veteran status)

Special Disabled Veteran: Means (a) a veteran 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 Veteran Affairs for a disability rated at 10 or 20 percent in the case of a veteran who has been determined to have a serious employment disability or (b) a person who was discharged or released from active duty because of a service-connected disability.

Vietnam Era Veteran: Means a veteran, any part of whose active military, naval, or air service, was dur- ing the period August 5, 1964 through May 7, 1975 who (1) served on active duty for a period of more than 180 days and was discharged or released therefrom with other than a dishonorable discharge, or (2) was dis- charged or released from active duty because of a service-connected disability.

Other Eligible Veterans: Veterans who served in a war, including veterans with active duty service between December 7, 1941 and April 28, 1952, or Veterans who served in a campaign or on an expedition for which a campaign badge, service medal, or an expeditionary medal has been awarded.

 

Disclosure to Employment Applicant

This is to notify you that a Consumer Report and/or Investigative Consumer Report will be conducted on you for employment purposes.

By signing the release below, I hereby authorize Country Club Bank to contact any and all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts, military services to release information about my background including, but not limited to, information about employment, education, consumer credit history, driving record, criminal record and general public records history to Country Club Bank.

I release from all liability all persons, companies, schools supplying such information. I indemnify Country Club Bank against any liability, which may result from making such requests. This release shall remain in effect for the length of my employment. I understand and I may have a right to request additional disclosures regarding the nature and scope of the investigation. I also understand that I will be given a copy of the consumer report and a written description of my rights under the Fair Credit Reporting Act.

I believe to the best of my knowledge that all information I have provided is accurate, true and correct and that I fully understand the terms of this release.

I Agree :

Date:   
Name:
Address:
* 200 characters max
City:       State:       Zip:  
Social Security:
DL Number:       State: