Otoe-Missouria Federal Credit Union - Employment Application

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An Equal Opportunity Employer

Last Name

First Name

Middle Name

Position Desired

Desired Hourly Wage or Salary?

Type of Employment

Full-TimePart-Time

When Can You Start?

Thank you for submitting this Employment Application to Otoe-Missouria Federal Credit Union.

To be considered for employment with Otoe-Missouria Federal Credit Union, YOU MUST COMPLETE THIS ENTIRE EMPLOYMENT APPLICATION. Do not leave any questions unanswered or any blanks without any information. We do not accept résumés instead of this Employment Application or to answer any questions in this Employment Application.

Otoe-Missouria Federal Credit Union considers all applicants for all positions without regard to sex, race, color, national origin, age, religion, disability, or any other applicable legally protected category. Otoe-Missouria Federal Credit Union also provides reasonable accommodations for applicants and employees with disabilities and bona fide religious beliefs. If you need any assistance in completing this application, please let us know.

Otoe-Missouria Federal Credit Union complies with all federal and state immigration laws requiring it to employ only United States citizens or foreign nationals who have a legal right to work in the United States. As a condition of employment, all employees must submit documentation showing they are legally authorized to work in the United States.

This Employment Application is not a contract. If you are accepted for employment, you will be employed at-will, which means either you or the Company may end your employment at any time.

This Employment Application is only valid for 90 days. If you wish to be considered for employment after 90 days, you must submit a new Employment Application.

Referral Source

How did you learn about Otoe-Missouria Federal Credit Union?

If other, please list

Personal Information

Please answer all questions. Resumes are NOT ACCEPTED as a way to answer any questions.

Home Address no P.O. Boxes permitted

City

State

ZIP Code

Social Security #

E-mail Address

Telephone #

Cellular/Other #

Criminal Record

Complete this section thoroughly. Please note that a criminal record does not necessarily disqualify you from employment.

Have you ever been convicted of a felony or misdemeanor?

YesNo

Have you ever committed or plead guilty or no contest to a felony or misdemeanor?

YesNo

(Include all such pleas, including probation before judgment, suspended imposition of sentence and deferred disposition even if adjudication was withheld.)

If you answered “Yes” to either question, please provide the dates, crimes, and sentences imposed.

Employment Information

Employment Experience

For the last 10 years, please identify all employers and provide detailed information for all periods of unemployment. This section must be completed in full.

Most Recent Employer

Company Name

Start Date

End Date

Supervisor’s Name

City

State

Zip Code

Telephone #

Most Recent Job Title

Duties Performed

Compensation

Reason for leaving (state whether you left voluntarily or not)

May we contact?

YesNo

Employer Two

Company Name

Start Date

End Date

Supervisor’s Name

City

State

Zip Code

Telephone #

Most Recent Job Title

Duties Performed

Compensation

Reason for leaving (state whether you left voluntarily or not)

May we contact?

YesNo

Employer Three

Company Name

Start Date

End Date

Supervisor’s Name

City

State

Zip Code

Telephone #

Most Recent Job Title

Duties Performed

Compensation

Reason for leaving (state whether you left voluntarily or not)

May we contact?

YesNo

Add More Employers

Employer Four

Company Name

Start Date

End Date

Supervisor’s Name

City

State

Zip Code

Telephone #

Most Recent Job Title

Duties Performed

Compensation

Reason for leaving (state whether you left voluntarily or not)

May we contact?

YesNo

Employer Five

Company Name

Start Date

End Date

Supervisor’s Name

City

State

Zip Code

Telephone #

Most Recent Job Title

Duties Performed

Compensation

Reason for leaving (state whether you left voluntarily or not)

May we contact?

YesNo

Employer Six

Company Name

Start Date

End Date

Supervisor’s Name

City

State

Zip Code

Telephone #

Most Recent Job Title

Duties Performed

Compensation

Reason for leaving (state whether you left voluntarily or not)

May we contact?

YesNo

Education

Resumes are not accepted as a response to this section.

High School

School Name

City & State

Did You Graduate?

YesNoCurrently Enrolled

College

School Name

City & State

Major/Area of Study

Did You Graduate?

YesNoCurrently Enrolled

Degree

Graduate School

School Name

City & State

Major/Area of Study

Did You Graduate?

YesNoCurrently Enrolled

Degree

Vocational/Technical School

School Name

City & State

Major/Area of Study

Did you Graduate?

YesNoCurrently Enrolled

Degree

Add More Schools

School Five

School Name

City & State

Major/Area of Study

Did you Graduate?

YesNoCurrently Enrolled

Degree

School Six

School Name

City & State

Major/Area of Study

Did you Graduate?

YesNoCurrently Enrolled

Degree

Other Training & Skills

Other Education & Training

Please list any educational seminars, courses, or other training you have received that qualifies you for the position for which you are applying.

Special Skills

Please list any special skills or experiences that qualifies you for the position you for which you are applying.

References

Reference One

Name

Telephone #

Relationship

How Long Known

Reference Two

Name

Telephone #

Relationship

How Long Known

Reference Three

Name

Telephone #

Relationship

How Long Known

Residence Information

Please list the city, county, and state for each place where you have resided within the last 10 (ten) years prior to today’s date.

Residence One - City, County, State

Years Resided

Residence Two - City, County, State

Years Resided

Residence Three - City, County, State

Years Resided

Add More Past Residences

Residence Four - City, County, State

Years Resided

Residence Five - City, County, State

Years Resided

Residence Six - City, County, State

Years Resided

Residence Seven - City, County, State

Years Resided

Residence Eight - City, County, State

Years Resided

Applicant's Certification, Authorization, & Release

Please read this section carefully, check all boxes to the left side of each statement, and sign and date below.

I certify that the information I provided in this Employment Application is correct and complete. I understand that any false or incomplete information may disqualify me for employment and it may also be grounds for termination of my employment if discovered after start working for the Company.*

I authorize the Company or its designated representatives to investigate the information I have provided in this Employment Application by contacting previous employers, schools, references, and others for verification. I hereby release, hold harmless, and indemnify the Company from any claims or liability resulting from its investigation of any information in this Employment Application. In addition, I release, hold harmless, and indemnify my previous employers, schools, references, and others from all claims or liability resulting from the Company’s investigation.*

I understand that if the Company offers me a job, it will be for no guaranteed period of time and either I or the Company can terminate the employment relationship with or without notice or cause at any time. I understand that no person other than the CEO of the Company can enter into employment agreements with any person and that neither this Employment Application nor any of the Company’s employment policies, whether contained in an employee handbook or not, constitute an employment contract or modification of my at-will employment relationship with the Company. I further understand that no oral or written representations by any Company representative shall be deemed to constitute the terms of an implied employment contract.*

I understand that any offer of employment will be contingent upon me completing any a satisfactory background check.*

I understand that the Company is a Drug-free Workplace and that any offer of employment with the Company will be contingent upon me passing a pre-employment drug test for controlled substances, which may involve submitting a urine sample. I hereby freely and voluntarily consent to this request and agree to participate in the Company’s drug testing program.*

I understand that the Company is an equal opportunity employer and that its policy is to make employment decisions without regard to sex, race, color, national origin, religion, age, disability, or any other applicable legally protected category. I agree that if at any time during the application or hiring process I believe I have been discriminated against on the basis of any legally protected category, I will raise that concern with the Company’s Human Resources Department immediately.*

Signature

Disclosure Regarding Consumer Reports
Please be advised that Otoe-Missouria Federal Credit Union (the “Company”) may obtain information about you from a third-party consumer reporting agency to evaluate your eligibility for employment purposes. Thus, you may be the subject of a consumer report which may include information about your character, general reputation, personal characteristics, or mode of living.

Disclosure Regarding Investigative Consumer Reports
Please be advised that Otoe-Missouria Federal Credit Union (the “Company”) may obtain an investigative consumer report about you from a third-party consumer reporting agency for employment purposes as part of the pre-employment background investigation and at any time during your employment. This report may include information about your character, general reputation, personal characteristics, and mode of living, and it may involve personal interviews with sources such as your neighbors, friends, and associates, as well as past and present employers, coworkers, references or others. You have the right, upon written request to the Company made within a reasonable period of time after receipt of this notice, to request a complete and accurate disclosure of the nature and scope of the investigative consumer report requested by the Company. You also have the right to request a summary of your rights under the federal Fair Credit Reporting Act.

Authorization
I hereby authorize Otoe-Missouria Federal Credit Union the Company”) to obtain consumer reports and investigative consumer reports about me at any time after receipt of this Authorization and, if I am hired, throughout my employment. To this end, I hereby authorize, without reservation, any person or entity, law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information to any third-party or agent deemed appropriate by the Company to perform background verification. I authorize persons, schools, current and former employers, and state and federal agencies, and other organizations to provide the Company with all information that may be requested.

The consumer report and/or the investigative consumer report may include, but is not limited to, employment history, reference checks, criminal and civil history information, motor vehicle records, moving violation reports, sex offender status information, credit reports, education verification, professional licensure verification, drug testing, and information related to my Social Security Number.

I understand that if any adverse action is to be taken based upon the report, a copy of the report and a summary of the consumer's rights will be provided to me. I agree that a facsimile, electronic or photographic copy of this Authorization shall be as valid as the original.

Signature (Type Name)

Date

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