Farmers Bank Employment Application

Employment Application

5/2021
Farmers Bank is an equal opportunity employer and does not discriminate on the basis of race, color, religion, age, sex, national origin, marital status, non-disqualifying disability or veterans' status.
Date

Month Day Year
Date
Full Legal Name *

First Name Middle Name Last Name
Phone Number *
E-mail *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Zip Code
Are you 18 years of age or older?

Yes No
Do you have reliable transportation?

Yes No
How were you referred to us?

Website VEC College/University Other
If an employee referred you, please list their name.

State all the hours you are available to work in the chart below.

	Monday	Tuesday	Wednesday	Thursday	Friday
From:
To:

Education History
High School Name
High School City, State
Years Attended
Focus of Study
Graduated

Yes No
College Name
Years Attended
Focus of Study
Graduated

Yes No
Other Education:
U.S. Military
Branch of Service
Type of Duty

	Date Started	Date Ended
Active Duty Date

What specialized training did you receive?
Employment History

Provide previous work experience, including service performed as an independent contractor as completely as possible, starting with your most recent work experience. Include summer employment, unemployed or self-employed periods; show dates and locations.
Most Recent Employer Name

	Date Started	Date Ended
Dates worked for

Most Recent Employer Address

Street Address

Street Address Line 2

City State

Zip Code
Salary
Type of Work Performed
Reason for Leaving
Supervisors Name and Position
Employer Name

	Date Started	Date Ended
Dates worked for

Employer Address

Street Address

Street Address Line 2

City State

Zip Code
Salary
Type of Work Performed
Reason for Leaving
Supervisors Name and Position
Employer Name

	Date Started	Date Ended
Dates worked for

Employer Address

Street Address

Street Address Line 2

City State

Zip Code
Salary
Type of Work Performed
Reason for Leaving
Supervisors Name and Position
References

Give the names of three person you are not related to and by who you have not been employed or to who you have provided services. These people should have known you for several years.
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State

Zip Code
Phone Number
Please enter a valid phone number.
Occupation
Years of Acquaintance
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State

Zip Code
Phone Number
Please enter a valid phone number.
Occupation
Years of Acquaintance
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State

Zip Code
Phone Number
Please enter a valid phone number.
Occupation
Years of Acquaintance
Additional information for consideration
Agreement
On entering the employ of Farmers Bank, I agree to observe all the rules of my employer and governmental regulations that may apply to my duties. I understand that any continuation of my employment will depend upon satisfactory replies on any background check and from my references, acceptance by the bonding company, and performance satisfactory at all times to my employer. I understand and agree that my employment is for no definite period of time and may, regardless of the date of payment of my wages and salary, be terminated, with or without cause or notice, and without liability for doing so at any time. I understand that no representative of Farmers Bank other than its President, has authority to enter into any agreement for employment for any specified period of time or make any agreement contrary to the foregoing, and that any such agreement, to be enforceable, must be in writing and signed by the President.

I further consent to any testing as may be required by Farmers Bank, including, but not limited to, drug and/or alcohol testing.

I certify that the information provided herein is true and complete to the best of my knowledge and belief. I understand and agree that providing false, incomplete, or misleading information will be grounds for a decision not to employ me or to terminate my employment immediately without liability for doing so.
Name

First Name Last Name
Signature

Clear
Date

Month Day Year
Date

Employment Application

Education History

U.S. Military

Employment History

References

Agreement

Voluntary Applicant Affirmative Action Information Sheet