Thank you for expressing your interest in employment opportunities with our organization. To continue in our selection process, please print and complete in full the attached application (which is in pdf format). Be sure to sign all the attachments and the back of the application. Please complete the entire application. An incomplete application may delay the processing of your application. Mail all items as soon as possible to: CO-OP Financial Services ATTN: Human Resources Department 21840 W. Nine Mile Road Southfield, MI 48075 Please place proper postage ($.82) on the envelope. We look forward to receiving your application. Sincerely, Human Resources Staff
Application for Employment CU Cooperative Systems Inc., its parent, affiliates and subsidiaries ( CO-OP ) are equal opportunity employers and do not discriminate in hiring or employment upon any basis prohibited by law. None of the questions or information sought in this application is intended to discriminate based upon any status protected by law. CO-OP may test applicants for drugs; if tested, applicants must pass the drug test to be eligible for employment. Please indicate the CO-OP Company to which you are applying: CO-OP Financial Services Lending Call Center Services, LLC Service Centers Corporation Credit Union Services Corporation (CUSC) FSCC, LLC Print Clearly Complete In Full Read And Sign Back Page Personal Information For Office Use Only Forward to Date of Application: Last Name: First Name: Middle Name: Social Security: / / / / Int. Date / / Time Br./Dept. Street Address: Apt. # Home Phone: City: State: Zip: Cell Phone: If hired, would you have reliable transportation to and from work: Yes No Email Address: Are you over 18 years of age? Yes No If not, can you obtain a work permit? Yes No If hired, can you provide verification of your legal right to work in the United States? Yes No Do you have friends or relatives employed here? Yes No If yes, state name(s) and relationship(s): Are your previous employment records under any other name than the one you now use? Yes No If yes, name: Have you been employed here before? Yes No If yes, date(s) Previous position: How were you referred to our Company? Have you filed an application here before? Yes No Reason for leaving: Ad Agency Employee Referral Other (Where) (Name) (Name) (please specify) Have you been discharged by a former employer or asked to resign? Yes No If yes, please explain Include explanation of any gaps in employment in the last ten years: Date Reason(s) for unemployment Employment Desired Position(s) applying for Full Time Part Time Please indicate days and hours available to work: M T W Th F Sat Sun Minimum salary desired $ per Date available to start work Revised: 06/15/2012 1
You must complete this section even if attaching a resume! Work Experience List below all present and past employment starting with your most recent employer. You must complete this section even if attaching a resume. Please use additional sheets of paper to list other past employment. Name of Company Type of Business Address of Company Phone / Street City State Zip Job Title Describe the work you did Reason For Leaving Supervisor s name May we contact for reference? Yes No If no, why? From Salary Mo./Yr Mo./Yr. Starting Ending Name of Company Type of Business Address of Company Phone / Street City State Zip Job Title Describe the work you did Reason For Leaving Supervisor s name May we contact for reference? Yes No If no, why? From Salary Mo./Yr Mo./Yr. Starting Ending Name of Company Type of Business Address of Company Phone / Street City State Zip Job Title Describe the work you did Reason For Leaving Supervisor s name May we contact for reference? Yes No If no, why? From Salary Mo./Yr Mo./Yr. Starting Ending Name of Company Type of Business Address of Company Phone / Street City State Zip Job Title Describe the work you did Reason For Leaving Supervisor s name May we contact for reference? Yes No If no, why? From Salary Mo./Yr Mo./Yr. Starting Ending Revised: 06/15/2012 2
Education School Level Name & Location of School Circle Last Year Completed Did You Graduate? List Degree, Diploma or Hours Completed High School 9 10 11 12 Undergraduate/ College Graduate/ Professional Other/ Specify 1 2 3 4 1 2 3 4 1 2 3 4 Additional Information Have you ever been convicted of a criminal offense (felony or misdemeanor) or subjected to deferred adjudication which has not been judicially ordered sealed, expunged, or statutorily eradicated? (If you are applying for a job in California, omit marijuana convictions under California Health and Safety code 11357(b) and (c), 11360(c), 11365 or 11550 (or statutory predecessor) that are more than two years old)? Yes No If yes, state the nature of the crime(s), when and where convicted and disposition of the case No applicant will be denied employment solely on the grounds of conviction of a criminal offense and/or deferred adjudication. The nature and gravity of the offense or sentence imposed, date of conviction, the surrounding circumstances, the relevance of the offense to the position(s) applied for, and any other relevant factors will be considered. Have you ever been covered by a surety bond? Yes No Have you ever been denied surety bond coverage or had a surety bond coverage revoked? Yes No If yes, please explain: Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodations? Yes No If no, describe the functions that you cannot perform Note: We comply with the ADA and State law and consider reasonable accommodation measures that may be necessary for employees to perform the essential functions. Skills Assessment List PC Software Skills and Experience: Beginner Intermediate Advanced Please indicate experience and skills that relate to the position(s) for which you are applying: Revised: 06/15/2012 3
Applicant s Authorization and Acknowledgment of Conditions Please read carefully, initial each paragraph and sign below. I certify that the answers given by me on this application are true, correct and complete, to the best of my knowledge. I understand that any misstatement, misrepresentation, or omission of facts on this application or any documents used to obtain employment may result in rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery of the misstatement or omission. I further certify that I, the applicant, have personally completed this application. Initials I authorize CU Cooperative Systems Inc., its parent, affiliates and subsidiaries ( CO-OP ) to investigate my references, prior employment, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed, all prior employers, and all educational institutions attended, to disclose to CO-OP any and all letters, reports, and other information related to my records, including, but not limited to, my performance reviews and evaluations, discipline, commendations, awards, and all other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers, and educational institutions attended, I release them, and their agents, employees, clients, or representatives, to the fullest extent permitted by law, from any liabilities for providing CO- OP with all information, and I release CO-OP, and its agents, employees, clients, or representatives, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities that may result from any use or disclosure of such information by CO-OP or any of its agents, employees, clients, or representatives. I authorize the physician or clinic to release to CO-OP results of any drug/alcohol test administered. I waive any claims based on the drug/alcohol test, and the release of the drug/alcohol test results to CO-OP. Initials I understand that any employment with CO-OP is at-will and at the mutual consent of me and CO-OP. Accordingly, either I or CO-OP may terminate my employment for any or no reason at any time, with or without cause, and with or without notice. I understand that except for CO-OP s CEO, no employee, representative, or agent of CO-OP has authority to modify the at-will nature of my employment, to enter into any employment agreement for a specified period of time, or to make any oral or written representation or to create any practice contrary to the at-will nature of my employment. Any modification of the at-will nature of my employment or any employment agreement for a specified period of time with CO-OP, must be set forth in a written agreement signed and dated by me and CO-OP s CEO. No oral statement, other written statement, policy, or practice can modify the atwill nature of my employment. In addition, I understand that if hired by CO-OP, this statement shall constitute a binding integrated agreement with respect to the at-will nature of my employment relationship and that there are no oral or written agreements of any kind contrary to the foregoing. Initials If this application is for a position in California, I hereby agree to submit to binding arbitration all disputes and claims I may have arising out of or related to my applying for employment with CU Cooperative Systems, Inc. and FSCC, LLC, in accordance with the provisions of the arbitration of disputes policy set forth in CU Cooperative Systems, Inc. and FSCC, LLC Employee Handbook. I further agree, in the event that I am hired by CU Cooperative Systems, Inc. or FSCC, LLC, that all disputes and claims that I may have that cannot be resolved by informal internal resolution which arise out of or are related to my employment with CU Cooperative Systems, Inc. or FSCC, LLC, whether during or after employment, will be submitted to binding arbitration to the fullest extent permitted by law. I have been given a copy of the arbitration of disputes policy set forth in CU Cooperative Systems, Inc. or FSCC, LLC Employee Handbook. I have read that policy and I knowingly, intentionally, and voluntarily agree to the provisions of that policy in all respects. Initials I certify that I am eligible to work in the United States for any U.S. employer. I further certify that I am able to provide documents that demonstrate my identity and work eligibility and that I will assist CO-OP in completing Form I-9 Employer Verification. I understand that any offer of employment is conditioned upon my providing satisfactory documentary proof of both my identity and my authorization to work in the United States, and that failure to produce such documents will result in revocation of the offer or termination of employment. Initials I also understand and agree that as a condition to being employed by CO-OP, I will be required to sign a Covenant Not to Disclose Confidential Information Agreement." Initials If I become employed, in consideration of my employment, I agree to comply with the rules, regulations, policies, and procedures of CO-OP. Initials If hired by Service Centers Corporation or CO-OP Financial Services and I work in Michigan, under Michigan law, I have 182 days from the date I know that an accommodation is needed to request, in writing, an accommodation. This time limit does not apply to reasonable accommodations requested under federal law, or if I am applying for a position in a state other than Michigan. Initials Applicant s Signature Date Revised: 06/15/2012 4
CO-OP FINANCIAL SERVICES Credit Union Family Service Centers PLEASE SELECT AND PRIORITIZE UP TO 3 LOCATIONS WHICH YOU WOULD BE INTERESED IN WORKING AT BY PLACING A NUMBER BESIDE THOSE LOCATIONS. YOU MAY BE CONSIDERED FOR ANY LOCATION YOU SELECT THAT HAS A POSITION AVAILABLE FOR WHICH YOU QUALIFY. MARYLAND AREA LOCATIONS Capitol Heights, Maryland Hampton Mall 9001 Central Avenue (Exit 15B off I-495) Marlow Heights, Maryland Marlow Heights Shopping Center 4003 Branch Avenue (Exit 7B off I-495) HR\RECRUIT\APPLICATION\INSERTS\DCAreaLocations.doc 7/13/10
Notice and Authorization for Consumer Credit Report As part of the application process, CO-OP Financial Services may obtain a consumer credit report for employment purposes. In completing this application for employment, I authorize CO-OP Financial Services to obtain a consumer credit report. I understand that the consumer credit report will contain information including, but not limited to, my credit-worthiness and credit-standing. Signature of Applicant / / Date Social Security Number HR\RECRUIT\APPLICATION\INSERTS\NoticeAndAuthorizationForConsumerCreditReport.doc
CO-OP FINANCIAL SERVICES TELLER INFORMATION FORM Name: Address: Date: Please clearly and legibly complete the following job-related questions. Answers are evaluated based on content. 1. How many hours a week are you working at your present job?(if not presently employed, how many hours were you working at your last job?) 2. What are the most rewarding aspects of your current position? (If not presently employed, what were the most rewarding aspects of your most recent position?) 3. What frustrates you most in your current position? (If not presently employed, what frustrated you most in your most recent position?) 4. If you have no cash handling experience, please skip this question and go to #5. a.) Please list all of your jobs that involved handling cash. At each of those jobs, what percentage of your work day was spent handling cash? Job/Employer %of time spent handling cash b.) What is (was) the average amount of cash you handle(d) on a daily basis? c.) Did any of your jobs require you to operate your own cash drawer (without sharing)? d.) At the end of your shift, who was responsible for counting your cash drawer? e.) How did that person verify whether the counted cash amount was correct or incorrect? f.) Did your employer have an over/short limit? If so, what is (was) the amount? g.) What percentage of time was your cash drawer correct? 5. Describe your ideal working environment? 6. What qualities and characteristics do you possess that would make you a good teller? 7. List three behaviors that you have that demonstrate good customer service: 1. 2. 3. HR\RECRUIT\APPLICATION\INSERTS\TellerInformationForm.doc 9/17/07
Application Addendum for All Maryland and Virginia Applicants Under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment, or continued employment, that an individual submit to or take a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100. Signature of Applicant / / Date HR\RECRUIT\APPLICATION\INSERTS\ApplicationAddendumForAllMarylandAndVirginiaApplicants.doc
DISCLOSURE REGARDING CONSUMER AND/OR INVESTIGATIVE REPORT The Employer, CO-OP Financial Services ( Company ) may obtain information about you for employment purposes from a third party consumer reporting agency. Thus, you may be the subject of a consumer report and/or an investigative consumer report which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, supervisors, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ( driving records ), verification of your education or employment history, or other background checks. Further, you understand that information may be requested from various Federal, State, County and other agencies that maintain records concerning your past activities relating to your driving, criminal, civil, education, credit, and other experiences. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable period of time after receipt of this notice, to request whether a consumer report has been conducted about you, disclosure of the nature and scope of any investigative consumer report, and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your employment and/or education history. The scope of this notice and authorization is all-encompassing, however, allowing the Company to obtain consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law, unless you otherwise revoke your consent by providing written notification to Company. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report. The consumer and/or investigative consumer report(s) will be obtained from: Accurate Background, Inc., 7515 Irvine Center Drive, Irvine, CA 92618, (800) 216-8024. Accurate Background s information and privacy policy can be found at www.accuratebackground.com. California applicants or employees only: By signing below, you also acknowledge receipt of A SUMMARY OF YOUR RIGHTS UNDER THE PROVISIONS OF CALIFORNIA CIVIL CODE 1786.22. Please check the appropriate box below if you would like to receive a copy of your investigative consumer report or consumer credit report at no charge. Minnesota and Oklahoma applicants or employees only: Please check the appropriate box below if you would like to receive a copy of your consumer report free of charge. New York and Maine applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by Company by contacting the consumer reporting agency identified above directly. You may also contact the Company to request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days. New York applicants or employees only: Upon request, you will be informed whether or not a consumer report was requested by Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing the authorization, you also acknowledge receipt of Article 23-A of the New York Correction Law. Oregon applicants or employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information, and remedies available should you suspect or find that the Company has not maintained secured records is available to you upon request. Washington State applicants or employees only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK I acknowledge receipt of the DISCLOSURE REGARDING CONSUMER AND/OR INVESTIGATIVE REPORT and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by the Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, local, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Accurate Background, Inc., 7515 Irvine Center Drive, Irvine, CA 92618 (800) 216-8024, www.accuratebackground.com, another outside organization acting on behalf of the Company, and/or the Company itself. I understand that by signing my name below, that I am signing the Authorization form directing the background check as described above, and I certify that: I have received the Disclosure Regarding Consumer and/or Investigative Report, have read and received the Summary of Your Rights, and if a California resident/applicant, the A Summary of Your Rights Under the Provisions of California Civil Code 1786.22. I understand that my signature now and throughout this process will be binding. Additionally, notices, documents, and communications may be provided electronically and will meet the requirements set forth under Federal and/or State law, as permitted by law. I agree that a facsimile ( fax ), electronic or printout of this authorization may be accepted with the same authority as the original. For California, Oklahoma, or Minnesota employees and applicants: Please check the appropriate box to indicate if you would like to receive a copy of your consumer report free of charge. Yes No Print Name Other Names Known By Social Security Number - - Date of Birth / / Driver s License Number State Current Address City State ZIP Applicant Signature Date Prospective Employer
CO-OP FINANCIAL SERVICES PART-TIME EMPLOYEE BENEFITS: COMPETITIVE PAY PAID TRAINING PAID HOLIDAYS PAID VACATION AND PERSONAL DAYS PAID SICK TIME 401(K) TUITION REIMBURSEMENT FLEXIBLE SPENDING ACCOUNT EMPLOYEE ASSISTANCE PROGRAM DEPENDENT CARE REFERRAL SERVICE AND MORE!! ADDITIONAL BENEFITS FOR FULL TIME EMPLOYEES MEDICAL, DENTAL & VISION INSURANCE DISABILITY INSURANCE LIFE INSURANCE HR\RECRUIT\APPLICATION\INSERTS\Part-TimeEmployeeBenefits.doc 5/01/07