| APPLICATION FOR EMPLOYMENT |
| Applicant Name : | | |
| First | Middle | Last |
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| Telephone: | Email Address: | Social Security Number: |
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| Address | City | State |
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| Zip |
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Are you 18 years old or older?
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| Are you either a U.S. citizen or an alien authorized to work in the U.S.?
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| Have you ever worked or attended school under another name? If so, under what name?
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| Have you ever been convicted, pled guilty or no contest to a crime other than a minor traffic conviction (for example, speeding tickets)?*
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| If yes, give details, including date(s):
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| * A “yes” answer will not automatically disqualify you from employment. We will consider the nature and date of the offense and the job for which you are applying for job-related purposes only, and only to the extent permitted by applicable law. |
| Position Desired |
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| Date you can start:
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| Hourly rate / monthly salary desired:
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| Do you prefer:
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| If part-time, hours per week desired:
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| Hours you are available to work:
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| Days of the week you are available to work:
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| Are you able to work: |
| Weekends*
| Nights*
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| * if required for the position for which you’re applying |
| Are you available to work overtime?
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| Have you previously worked for this company?
| If so from
to
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| Reason for leaving:
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| Former supervisor(s) at this company:
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| How did you learn about this opening?
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| Have you ever been terminated from employment or asked to resign in lieu of termination?
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| If so, explain: |
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| Attach Resume: |
| Education |
| High School: | Graduated | Course of Study: |
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| Technical School: | Graduated | Course of Study: |
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| College / University: | Graduated | Course of Study: |
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| Other education or training: |
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| Other special skills: |
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| Work Experience |
| Employer:
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| Address | City | State |
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| From
to
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| Position Held:
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| Reason for Leaving
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| Supervisors Name Title
| Telephone
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| May we contact?
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| Description of Duties:
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| Starting Hourly Pay:
| Final Hourly Pay:
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| Employer:
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| Address | City | State |
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| From
to
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| Position Held:
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| Reason for Leaving
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| Supervisors Name Title
| Telephone
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| May we contact?
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| Description of Duties:
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| Starting Hourly Pay:
| Final Hourly Pay:
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| Employer:
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| Address | City | State |
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| From
to
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| Position Held:
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| Reason for Leaving
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| Supervisors Name Title
| Telephone
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| May we contact?
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| Description of Duties:
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| Starting Hourly Pay:
| Final Hourly Pay:
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| References |
| Give names, addresses and phone numbers of at least four people who are not related to you and who have known you for at least 1 year. Please indicate how you know each reference and how long you have been acquainted. Former employers, coworkers or educators are preferred. Complete all information necessary for us to contact each reference by phone and/or mail. |
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| Authorization and Acknowledgments |
I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that if I am employed, any false statements or omissions on this application or any other materials I have submitted in support of my application may be grounds for dismissal.
I authorize investigation of all statements contained in this application. I also grant permission to contact all references listed above, and authorize them to release all information concerning my previous employment and any other pertinent information these references might have, personal or otherwise. I release all parties from all liability for any damage that may result from furnishing this information to you. I agree that any offer of employment is contingent on successful completion of a background investigation by the Bank.
I understand and agree that, if hired, my employment is “at will.” I understand that either I or Cornerstone Bank are free to terminate the employment relationship at any time for any lawful reason with or without prior notice. |
| Applicant Name:
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| Date:
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