FARM CREDIT OF SOUTHERN COLORADO

Please answer each question completely and accurately.

NAME

HOME PHONE

EMAIL*

example@example.com

Address

Street Address

CityState / Province

Postal / Zip Code

ARE YOU OVER 18 YRS. OF AGE?

YesNo

ARE YOU AUTHORIZED TO WORK IN THE U.S.?

YesNo

POSITION APPLYING FOR

Type of Employment

RegularFull TimeTemporaryPart Time

DATE AVAILABLE

Date

HOW WERE YOU REFERRED TO US?

NAMES OF FCSC EMPLOYEE REFERRAL

SCHOOL (HIGHEST LEVEL COMPLETED)

CITY

STATE

GRADUATED? (YES/NO)

HIGHEST DEGREE

DEGREE CURRICULUM

PROFESSIONAL LICENSES AND CERTIFICATIONS

AFFILIATIONS WITH PROFESSIONAL ORGANIZATIONS

DO YOU WANT US TO NOTIFY YOU BEFORE WE CONTACT YOUR PRESENT EMPLOYER?

YesNo

MOST RECENT EMPLOYER

JOB TITLE

Starting Date: Month

Starting Date: Year

Ending Date: Month

Ending Date: Year

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

TELEPHONE NUMBER

REASON FOR LEAVING

DUTIES

YOUR ANSWERS TO THE FOLLOWING QUESTIONS WILL NOT ELIMINATE YOU FROM CONSIDERATION FOR EMPLOYMENT, WITH THE EXCEPTION OF A CONVICTION OF A FELONY OR A CONVICTION WHICH INVOLVES DISHONESTY OR BREACH OF TRUST. THE FARM CREDIT ACT PROHIBITS SUCH PERSON(S) BEING EMPLOYED WITH FARM CREDIT INSTITUTIONS.

DO YOU HOLD AN ELECTIVE OR APPOINTED FEDERAL, STATE OR LOCAL GOVERNMENT OFFICE?

YesNo

IF YES, GIVE NAME OF OFFICE

ORGANIZATION

ARE YOU AN OFFICER OR DIRECTOR OF ANY BANK OR OTHER LENDING CORPORATION?

YesNo

IF YES, GIVE NAME AND LOCATION OF THE ORGANIZATION:

ARE YOU OR ANY MEMBER OF YOUR FAMILY A BORROWER OF ANY ORGANIZATION UNDER THE SUPERVISION OF THE FARM CREDIT ADMINISTRATION?

YesNo

IF YES, PLEASE EXPLAIN

DO YOU HAVE ANY RELATIVE(S) EMPLOYED BY FARM CREDIT SERVICES OR FARM CREDIT ADMINISTRATION?

YesNo

IF YES, GIVE NAME AND LOCATION OF FACILITY

Upload Resume (Optional)

Upload CV, or Other Documents (Optional)

MY ANSWERS ON THIS APPLICATION AND ON ANY RESUME / PROVIDE ARE COMPLETE AND TRUE. / UNDERSTAND THAT THE SUBMISSION OF ANY FALSE OR INCOMPLETE INFORMATION IN CONNECTION WITH MY APPLICATION, WHETHER ON THIS OR OTHER DOCUMENTS OR IN INTERVIEWS, WILL BE CAUSE FOR THE REJECTION OF MY APPLICATION OR THE TERMINATION OF MY EMPLOYMENT AT ANY TIME. I AUTHORIZE THE EMPLOYER AND ITS AGENTS TO VERIFY ANY INFORMATION RELATED TO MY APPLICATION OR RESUME. I ALSO AUTHORIZE AND DIRECT INDIVIDUALS, SCHOOLS, EMPLOYERS, AND LAW ENFORCEMENT OR GOVERNMENT OFFICIALS TO FREELY PROVIDE ANY INFORMATION CONCERNING MY BACKGROUND, AND HEREBY RELEASE ANY AND ALL OF THEM FROM ANY LIABILITY FOR DOING SO. IF I AM EMPLOYED, I UNDERSTAND THAT I WILL BE EMPLOYED ON AN AT-WILL BASIS FOR AN INDEFINITE PERIOD OF TIME AND THAT MY EMPLOYER MAY TERMINATE MY EMPLOYMENT AT ANY TIME AND FOR ANY REASON. THIS COMPANY IS AN EQUAL OPPORTUNITY EMPLOYER. INDIVIDUALS ARE JUDGED SOLELY ON THE BASIS OF THEIR QUALIFICATIONS AND WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, AGE, DISABILITY, NATIONAL ORIGIN, POLITICAL AFFILIATION MARITAL STATUS, STATUS WITH REGARD TO PUBLIC ASSISTANCE OR ANY OTHER PROTECTED CLASS.

FARM CREDIT OF SOUTHERN COLORADO IS AN EQUAL OPPORTUNITY EMPLOYER

SIGNATURE*

DATE

Date

EMPLOYMENT APPLICATION

PERSONAL & EMPLOYMENT DATA

EDUCATIONAL & PROFESSIONAL HISTORY

EMPLOYMENT HISTORY

BACKGROUND INFORMATION