Instructions: Please complete this application, save it on your computer and attach/send it via to

Transcription

1 Application for Employment Applicants are considered for positions without regard for race, color, religion, sex, national origin, age, marital or veteran status, the presence of a physical or mental disability or any other characteristic protected by federal, state or local laws, regulations or ordinances. Instructions: Please complete this application, save it on your computer and attach/send it via to hr.online@bankwithunited.com. Social Security Number: - - Date: Name: Last First Middle Name You Go By Number Street City State Zip Home Phone: ( ) Daytime Phone: ( ) Please indicate how you heard of available positions at United Bank and the name of that source:! Advertisement! Internet! Walk-In! United Bank Employee:! United Website! Agency! Job Fair Employee s Name Are you: (please check the appropriate response) At least 18 years of age? Yes Able to provide proof of authorization to work in the U.S.? Yes Under a non-competition agreement with current or former employer? Yes Able to perform business travel? (If required) Yes Able to work overtime? (If required) Yes A former United Bank employee? IF YES, explain: Dates of prior employment: to Position held: Yes Related to any current United Bank employee? IF YES: Name/relationship of relative(s): Yes Position for which you are applying: Date of Availability:

2 EMPLOYMENT HISTORY: List your last four jobs, with most recent first. Include military service, if applicable. Please fill out completely, even if attaching a resume. Company Name: Supervisor: Phone: May we contact? Yes Employed From: To Salary - Starting $ Ending $ Job Title & Description of Duties: Reason for Leaving: Company Name: Supervisor: Phone: May we contact? Yes Employed From: To Salary - Starting $ Ending $ Job Title & Description of Duties: Reason for Leaving: Company Name: Supervisor: Phone: May we contact? Yes Employed From: To Salary - Starting $ Ending $ Job Title & Description of Duties: Reason for Leaving: Company Name: Supervisor: Phone: May we contact? Yes Employed From: To Salary - Starting $ Ending $ Description of Duties: Reason for Leaving:

3 Are you presently employed at the most recent employer shown? Yes Explain any gaps in work history: Do you have any commitments to another employer that might affect your employment with United Bank? Yes IF YES, please explain, Have you ever been discharged or asked to resign for misconduct or unsatisfactory performance? Yes IF YES, please explain, Business or Professional References List the names and contact information for three people familiar with your work experience and/or performance. Each will be contacted prior to considering you for employment. Name Years Known Occupation Address Phone Education and Training Type of School School Name & Address Dates Attended Type of Degree, Diploma or Certificate High School To College or University To Other To *te number of credit hours completed if no degree obtained. List any relevant professional certifications, memberships or additional training that pertain to the position for which you are applying. DO NOT include any reference to any organization, which could identify your race, gender, religion, national origin or other protected status.

4 Please Read Carefully and Sign Below: I certify that application represents, to the best of my knowledge, an accurate and complete statement of the facts. I understand that any misrepresentation or omission of any fact requested, or in any other statements made in my request for employment, will be sufficient cause for rejection as a candidate, or may result a withdrawal of an employment offer, or may result in my discharge from employment if I am already employed at the time the misrepresentation or omission is discovered. I have no objection to any investigation regarding these facts and agree to indemnify United Bank against any liability, which might result in conducting such investigation. This application shall be valid for 90 days from this date. In submitting this application for employment with United Bank, I understand the following: 1. United Bank is an equal opportunity employer. 2. conversations between United Bank personnel and me are to be construed as any offer or commitment for employment. 3. Any offer of employment must be made in a letter, signed by the Department Head or his/her designee. 4. I understand that, if employed by United Bank, my employment will not be for a stated period and that I will have the right to terminate my employment at any time, and United Bank will retain a similar right. 5. I must sign this agreement prior to being considered as a candidate for a position with United Bank. I have read and understood this agreement: Signature Date Print Name DO NOT COMPLETE THIS SECTION AJS File Only Position Applied For: Requisition #: Source Code: Application Status: Disposition Code: EEO Data: Years of Banking: Years of Cash Handling Experience:

5 A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identify theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. In addition, as of September 2005, all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information. You have the right to ask for a credit score. Credit scores are numerical summaries of your creditworthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. PLEASE KEEP THIS PAGE FOR YOUR RECORDS

6 Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at OPTOUT. You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are: TYPE OF BUSINESS: Consumer reporting agencies, creditors and others not listed below National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name) Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name) Federal credit unions (words "Federal Credit Union" appear in institution's name) State-chartered banks that are not members of the Federal Reserve System CONTACT: Federal Trade Commission: Consumer Response Center - FCRA Washington, DC Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC Federal Reserve Board Division of Consumer & Community Affairs Washington, DC Office of Thrift Supervision Consumer Complaints Washington, DC National Credit Union Administration 1775 Duke Skeet Alexandria, VA Federal Deposit Insurance Corporation Consumer Response Center, 2345 Grand Avenue, Suite 100 Kansas City, Missouri Department of Transportation, Office of Financial Management Washington, DC Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act, 1921 Department of Agriculture Office of Deputy Administrator - GlPSA Washington, DC Para informacion en espanol, visite o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N. W., Washington, D.C PLEASE KEEP THIS PAGE FOR YOUR RECORDS

7 NOTICE REGARDING BACKGROUND INVESTIGATION IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT You have applied for employment with United Bank (the Bank ). In evaluating your application the Bank may, upon execution of this authorization, investigate the information contained in your employment application and other relevant background information to determine whether you are a suitable candidate for employment. You may be the subject of a consumer report and/or investigative consumer report requested by the Bank from an outside agency. A consumer report may contain information obtained from an outside agency on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and mode of living which will be used to establish your eligibility for employment. An investigative consumer report may contain information about your character, general reputation, personal characteristics, and mode of living and is obtained through personal interviews with neighbors, friends, associates, acquaintances, or others who may have knowledge concerning any such items of information. If you authorize a consumer report/investigative consumer report, you have certain rights which are explained in the attached A Summary of Your Rights Under the Fair Credit Reporting Act. You have the right, upon written request made within a reasonable time after receipt of this notice, to obtain information from the Bank: (1) As to whether an investigative consumer report has been requested; (2) If an investigative consumer report has been requested, written disclosure of the nature and scope of the investigation requested, and; (3) The name and address of the outside agency to whom requests for any of these reports has been made. In the event that information from the report is utilized in whole or in part in making an adverse employment decision, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the Fair Credit Reporting Act. ACKNOWLEDGMENT AND AUTHORIZATION I acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION and the SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of these forms. In addition, I authorize United Bank to obtain a consumer report and/or investigative consumer report or other background information. I hereby authorize any previous employers to release to United Bank information regarding my employment. Printed Name (first, middle, last): Maiden Name: Social Security Number: Date of Birth: Driver s License Number: State of Issue: HOME ADDRESS FOR PAST TEN YEARS (Use reverse side if more space is needed.) Street Address City State Zip County Month Year To Month Year DATE:

8 APPLICANT INFORMATION United Bank is an Equal Opportunity/ Affirmative Action Employer The following information is requested from all applicants for purposes of complying with Equal Opportunity and Affirmative Action laws and regulations. Completion of this form is VOLUNTARY and all information will be maintained in a confidential manner. The information is not used or considered in the selection process and is filed separately from the employment application. Please Print Name (Last, First, Middle Initial) Date of Birth (mm/dd/yyyy) Social Security Number - - Gender! Female! Male! I decline to state Race/Ethnic Category! American Indian or Alaskan Native! Asian! Black or African American! Hispanic or Latino (white race only)! Hispanic or Latino (all other races)! Native Hawaiian or other Pacific Islander! White! I decline to state Decline! I DECLINE TO STATE Signature Date Race/Ethnic Category Definitions: American Indian or Alaskan Native A person having origins in any of the original peoples of rth America and South America (including Central America), and who maintains tribal affiliation or community attachment. Asian A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. Black or African American A person having origins in any of the Black racial groups of Africa. Hispanic or Latino (White race only) A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of the White race. Hispanic or Latino (all other races) A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of any race other than White race. Native Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White A person having origins in any of the originals peoples of Europe, rth Africa or the Middle East.