Employment Application

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.

* - Indicates required field

Personal Information

First Name*	Middle Name	Last Name*
Other First and Last Names Used
Address*
City*	State*	Zip*
Primary Phone*	Secondary Phone	Email*
Position(s) applying for*	What is your desired salary range or hourly rate of pay?*	Per*
Referral Source	Have you applied here before?*	If yes, give date:
	Yes No
Are you available to work*	Are you over the age of 18?*	Are you eligible to work in the United States?*
Select One Full Time Part Time Shift Work Temporary	Yes No	Yes No
Are you fluent in a foreign language (if applicable)?*	What language?
Yes No
Are you currently employed?*	Dates available for work*
Yes No

Education Information

Name and Location of School

High School / GED*	Did you Graduate?*	Degree / Certification*
	Yes No
Trade School	Did you Graduate?	Degree / Certification
	Yes No
College	Did you Graduate	Degree / Certification
	Yes No
Graduate	Did you graduate:	Degree / Certification
	Yes No

Skills and Qualifications

Summarize experience, skills, special training, licenses, or certifications that may assist you in performing the position for which you are applying.

References

Please list name and telephone number of three professional references who are not related to you and that you have known for at least one year. Include at least one previous supervisor. Please provide the best telephone number to reach each contact.

Reference 1

Name*	Company*
Telephone*	Relationship to You & Years Known*

Reference 2

Name*	Company*
Phone*	Relationship to You & Years Known*

Reference 3

Name*	Company*
Phone*	Relationship to You & Years Known*

Employment History

Please complete every space. Starting with your most recent employer, provide the following information:

Employer One

Employer*	City & State*
Position Held*
Start Date*	End Date*
Supervisor*	May we contact for a reference?*
	Yes No Later
Supervisor Direct Phone*	Supervisor Email*
Starting Salary*	Ending Salary*
Responsibilities*
Reason for Leaving*
What did you like most about your position?*
What did you like least about your position?*

Employer Two

Employer	City & State
Job Title
Start Date	End Date
Supervisor Name & Title	May we contact for a reference?
	Yes No Later
Supervisor Direct Phone	Supervisor Email
Starting Salary	Ending Salary
Responsibilities
Reason for Leaving
What did you like most about your position?
What did you like least about your position?

Employer Three

Employer	City & State
Start Date	End Date
Job Title
Supervisor Name & Title	May we contact for a reference?
	Yes No Later
Supervisor Direct Phone	Supervisor Email
Starting Salary	Ending Salary
Responsibilities
Reason for Leaving
What did you like most about your position?
What did you like least about your position?

Military

Branch of Service	Discharge Date:
Discharge Rank

Additional Information

List any additional information you would like us to consider

Authorization

I understand that kstate CREDIT UNION is not making an 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 for employment or for termination, if employed.

I authorize kstate 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 individuals, including current or former employers, to provide 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 kstate CREDIT UNION. I acknowledge that a facsimile or photocopy of this form is as valid as the original.

Offers of employment are contingent upon finalizing pre-employment actions, which may include: drug test and/or physical examination, or other items may be required. kstate CREDIT UNION may withdraw an offer of employment any time for any reason prior to the original agreed upon start date, or after should results come back later.

I understand that this application is current for 60 days. At the conclusion of this time, if I have not heard from kstate CREDIT UNION and still wish to be considered for employment, it will be necessary to complete a new application.

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

Applicant's Electronic Signature (type full name)*		Date*

Equal Employment Opportunity Compliance

Clients of Scott Human Resources that are required by law to extend equal employment opportunities do so as required. Applicants are considered regardless of race, color, national origin, religion, gender, age, martial status, veteran status, medical condition, disability, or any other legally protected status. Equal access to the hiring process, services, and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the human resource representative.

Before submitting, please type in the security code below*