Mint Valley CU Employment Application

Our company is an Equal Opportunity Employer. All applicants will be considered regardless of race, color, religion, sex, national origin, age, marital or veteran status; medical condition, disability; or any other legally protected status. Equal access to the hiring process, services and employment is available to all persons.

Each question should be answered completely and accurately. No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the U.S. will be required if an employment offer is made.

Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Position you're applying for:*

Have you filed an application here before? If yes, give date.*

Are you employed now?*

YesNo

On what date would you be available for work?*

Date

May we contact your present employer?*

YesNo

What is your work availability?*

Full-timePart-time

If part-time, please list the hours you're available.*

Are you fluent in any other languages than English? Please list if so. If not, please answer "no"*

Are you over the age of 18?*

YesNo

Have you ever had any Bond coverage modified or revoked or has any application for Bonding been declined? Yes or no. If yes, please explain.*

Are you eligible to work in the United States? Proof of Citizenship or Immigration Status will be required upon employment.*

YesNo

Have you been convicted of a felony or misdemeanor other than moving traffic violations? If yes, please complete the following (a conviction record will not necessarily be a bar to employment).

Have you been convicted of a felony or misdemeanor other than moving traffic violations? If yes, please complete the following (a conviction record will not necessarily be a bar to employment). Please list conviction, Location, Date, and Result or Outcome*

If you attended High School, please list school name, if you received your degree, and any honors received. If not, please answer N/A.*

If you attended College/University, please list School Name, Diploma/Degree, Honors Received, and Course of Study. If not, please answer N/A.*

If you attended Graduate/Professional school, please list School Name, Diploma/Degree, Honors Received, and Course of Study. If not, please answer N/A.*

If you have a resume, please upload here:

WORK EXPERIENCE

Please list the places you've worked in order from most recent to least.

Company Name #1:*

Start Date:*

Date

Do you still work here? If not, please enter final day of employment.*

Phone Number:*

Please enter a valid phone number.

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Job Title:*

Supervisor:*

Starting Salary*

Ending Salary*

Reason for Leaving:*

Work Experience #2

Company Name #2:*

Start Date:*

Date

End Date:*

Date

Phone Number:*

Please enter a valid phone number.

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Job Title:*

Supervisor:*

Starting Salary*

Ending Salary*

Reason for Leaving:*

WORK EXPERIENCE #3

Company Name #3:*

Start Date:*

Date

End Date:*

Date

Phone Number:*

Please enter a valid phone number.

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Job Title:*

Supervisor:*

Starting Salary*

Ending Salary*

Reason for Leaving:*

REFERENCES

Give name and telephone number of three business/work references who are not related to you. List at least one of your previous employers.

Reference #1*

Name | Relationship/Occupation | Daytime Phone

Reference #2*

Name | Relationship/Occupation | Daytime Phone

Reference #3*

Name | Relationship/Occupation | Daytime Phone

TELL US A LITTLE MORE ABOUT YOU!

What has been your proudest moment in life so far?*

If you won the lottery tomorrow, what would you do and why?*

ACKNOWLEDGMENT

I understand that Mint Valley Federal Credit Union is making no employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration from employment or for termination if employed.

I authorize the credit union to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job related. I give my full consent for all contacted persons including former employers to provide the information concerning this application, and I waive my right to bring any cause of action against these individuals for any and all liability for damages arising from furnishing the requested information to the credit union.

A credit union paid drug test and/or physical examination may be required. I understand that any offer of employment may be withdrawn if I test positive for drugs and/or if a condition is discovered for which no reasonable accommodation can be made.

I understand that this application is current for only 60 days. At the conclusion of this time, if I have not heard from the credit union and still wish to be considered for employment, it will be necessary to fill out a new application.

I understand that if I am hired, my employment at the credit union is “at-will” and may be terminated by myself or the credit union at any time for any reason, with or without cause or notice. I understand that no representative of the credit union has the authority to make any assurance to the contrary.

Signature*

Today's Date:*

Date

AUTHORIZATION TO RELEASE INFORMATION

I authorize and request any present or former employer, educational institution, law enforcement agency, financial institution, or other person or organization having relevant information about me to furnish it to the credit union, and/or its agents in connection with an application for or retention of employment.

I agree not to assert any claims or causes of action against all persons and corporations supplying this information to the credit union and/or its agents. A photocopy of this authorization is as effective as the original.

Signature*

Today's Date:*

Date

Mint Valley Federal Credit Union Background Check Release Form

As part of the employment process, Mint Valley Federal Credit Union reserves the right to perform certain background checks on job applicants, whether new candidates or existing employees. These checks include but not limited to verifying references, educational achievements and personal background and obtaining reports relating to credit history, motor vehicle citations criminal history, and bondability. All background checks will be conducted on a non-discriminatory basis, in accordance with applicable federal and state law.

Falsified information supplied by an applicant may result in disqualification of employment. Discovery of falsified information after employment may lead to corrective action up to and including termination.

Every practical effort will be made to obtain complete verification and necessary reports before an offer of employment is made. When necessary job offers may be made contingent upon future receipt of acceptable background checks.

By signing below I am authorizing; former employers, educational institutions’ and other agencies and persons to provide Mint Valley Federal Credit Union with employment related information.

Name*

First NameLast Name

Signature*

Today's Date*

Date

By signing below I am authorizing Mint Valley Federal Credit Union to obtain consumer credit reports, bondability reports, criminal history background checks and other applicable or necessary information.

Signature*

Today's Date:*

Date