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LIST OF EMPLOYERS BEGINNING WITH PRESENT OR MOST RECENT |
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NAME OF EMPLOYER |
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LOCATION EMPLOYED |
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PHONE |
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FROM-MO/YR |
TO-MO/YR |
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YOUR TITLE |
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SUPERVISOR AND TITLE |
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STARTING SALARY |
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FINAL SALARY |
IF STILL EMPLOYED |
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MAY WE CONTACT |
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Yes |
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No |
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PRESENT EMPLOYER? |
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REASON(S) FOR LEAVING |
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DESCRIBE YOUR PRINCIPAL RESPONSIBILITIES |
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NAME OF EMPLOYER |
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LOCATION EMPLOYED |
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PHONE |
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FROM-MO/YR |
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TO-MO/YR |
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YOUR TITLE |
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SUPERVISOR AND TITLE |
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STARTING SALARY |
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FINAL SALARY |
MAY WE CONTACT |
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Yes |
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No |
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PRESENT EMPLOYER? |
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REASON(S) FOR LEAVING |
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DESCRIBE YOUR PRINCIPAL RESPONSIBILITIES |
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DATA |
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NAME OF EMPLOYER |
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LOCATION EMPLOYED |
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PHONE |
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FROM-MO/YR |
TO-MO/YR |
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EMPLOYMENT |
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YOUR TITLE |
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SUPERVISOR AND TITLE |
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STARTING SALARY |
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FINAL SALARY |
MAY WE CONTACT |
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Yes |
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No |
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PRESENT EMPLOYER? |
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REASON(S) FOR LEAVING |
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DESCRIBE YOUR PRINCIPAL RESPONSIBILITIES |
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NAME OF EMPLOYER |
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LOCATION EMPLOYED |
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PHONE |
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FROM-MO/YR |
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TO-MO/YR |
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YOUR TITLE |
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SUPERVISOR AND TITLE |
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STARTING SALARY |
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FINAL SALARY |
MAY WE CONTACT |
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Yes |
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No |
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PRESENT EMPLOYER? |
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REASON(S) FOR LEAVING |
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DESCRIBE YOUR PRINCIPAL RESPONSIBILITIES |
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OTHER EMPLOYERS WITHIN THE PAST 10 YEARS, IF APPLICABLE |
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DATES |
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NAME OF EMPLOYER |
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FROM |
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TO |
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POSITION |
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** Conviction will not necessarily bar employment. Consideration will be given to the nature of the crime, its seriousness, age at time of offense, rehabilitation and position for which you are applying.
I certify that the foregoing statements are true and correct. I understand that the falsification or material omission of any of the information requested on this form or during my pre-employment interview will result in rejection of this application or, if discovered during my employment, may result in my dismissal. I authorize each person and entity identified above to disclose to the Bank any and all information they may have concerning me, including my past performance, employment record and character. I expressly release these persons from any and all liability for furnishing responses to these inquiries.
I authorize the bank to investigate my credit and my employment and personal background. If I am denied employment as a result of a credit report, the bank will inform me of this reason and the name and address of the reporting agency that supplied the report.
I understand and agree that from time to time the Bank may require me to submit to a drug and/or alcohol test, and that refusal to submit to such test will be grounds for refusal to hire me or termination of my employment if already hired.
The Bank, at its own expense, arranges for a surety bond for each of its employees. I understand that if the bonding company refuses my application for a bond for any reason, the bank, in its sole discretion, may hire or retain me as an employee. I agree that, if my position requires me to use a motor vehicle, I will maintain a safe driving record, both on and off the job, and a valid appropriate driver’s license, as a condition of my continued employment.
I further agree that, upon request at any time, I will submit to drug and/or alcohol testing, and/or a physical examination by a bank physician, as a condition of my initial or continued employment. Any such testing or examination will be at the Bank’s expense.
I understand and agree that all disputes between IBC and me concerning my employment or the termination thereof will be submitted to arbitration in accordance with the National Rules for the Resolution of Employment Disputes of the American Arbitration Association which are in effect at the time the dispute arises.
I understand and agree that, if I am employed by the Bank, then regardless of the stated frequency of payment of my wages or salary (e.g., per month, per year), the Bank may terminate my employment at any time, with or without cause or prior notice, and no promises to the contrary shall be binding upon the Bank unless committed to writing and signed by me and the President of the Bank. If employed, I agree to comply with all rules and regulations of the Bank at present and as modified from time to time during my employment including, without limitation, the agreement to arbitrate any disputes between me and the bank.
APPLICANT’S SIGNATURE