Equity Bank Application

Applicant Name:*

Date:*

Telephone Number:*

Your Email:

Position(s) Applied For or Type of Work Desired:*

Type of Employment Desired:
 Full Time Part Time Temporary Educational Co-Op Seasonal

Date you will be available to start work:

Referral Source:
 Walk-In Employee Advertisement Company's Website School Job Fair Staffing Agency Government Employment Agency other

Have you ever submitted an application here before?
 Yes No

If yes, please list the dates and position(s):

Have you ever been employed here before?
 Yes No

If yes, please list the dates and position(s):

Can you submit proof of legal employment authorization and identity?
 Yes No

Will you relocate if the job requires it?
 Yes No

Will you travel if the job requires it?
 Yes No

If they have been explainted to you, are you able to meet the attendance requirements of the position?
 Yes No

Will you work overtime if required?
 Yes No

If no, please explain:

Drivers license number (if driving is an essential job duty):

Have you ever been bonded?
{radio bonded "Yes" "No"]

Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Have you ever pled "guilty" or "no contest" to, or been convicted of a criminal offense?
{radio criminal "Yes" "No"]

If yes, please describe in the space listing the incident, state & charge (a conviction will not automatically bar employment):

Were you ever discharged or forced to resign from any position?
 Yes No

Employment History

May we contact your current employer?
 Yes No

Please provide the name of the employer, address, telephone number, immediate supervisor and title, dates of employment, starting and ending compensation, a summary of the type of work performed and responsibilities and reason for leaving:

Employer 1:

Employer 2:

Employer 3:

Employer 4:

Skills and Qualifications

Summarize any job-related training, skills, licenses, certificates, and/or other qualifications:

Computer Skills (Please include software titles and years of experience)

Word Processing:

Spreadsheets:

Presentations:

Email:

Other Computer Skills or Software::

Educational History

List school name and location, years completed, course of study, and any degrees earned:

High School:

College:

Technical Training:

Other:

References

List 3 references names, telephone numbers, and years known (include only individuals familiar with your work ability). Do not include relatives or names of supervisors listed above in the employment history:

Related Information

To what job-related organizations (professional, trade, etc.) do you belong? Please exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities or any other protected status.

List special accomplishments, publications, awards, etc. Please exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities or any other protected status.

In your current or prior job, have you ever written instructions or directions to be followed by employees or customers?
 Yes No

If yes, please explain:

Is there any other job-related information you want us to know about you?

Applicant Signature* (type name into box)