Employment Application

INSTRUCTIONS: Please complete all portions of this employment application to be considered for employment. If you require accommodation during the employment process, including assistance in the completion of this employment application, please let us know. We are an equal opportunity employer. We do not discriminate on the basis of age, race, sex, religion, color, national origin, ancestry, marital status, disability, sexual orientation, arrest and court record or any other protected category recognized by state and federal laws. This employment application is valid for a three month period after submission to the credit union and only for the desired position. Consideration for employment after the three-month period requires completion and submission of a new application.

* indicates a required field.

*Social Security Number:

Social Security Number SSN Part 1 - Social Security Number SSN Part 2 - Social Security Number SSN Part 3

(for bondability and criminal conviction checks)

Present Address:

Present Address Street

Present Address Apartment Number

Present Address City

Present Address State

Present Address Zip Code

Mailing Address(if different than above):

Mailing Address(if different than above) Street

Mailing Address(if different than above) Apartment Number

Mailing Address(if different than above) City

Mailing Address(if different than above) State

Mailing Address(if different than above) Zip Code

Work:

Work Area Code( ) Work Part 1 - Work Part 2 Work Extensionext:

Alternate Phone:

Alternate Phone Area Code( ) Alternate Phone Part 1 - Alternate Phone Part 2 Alternate Phone Extensionext:

*Have you ever used any other names?

Yes  No

(for background and criminal conviction checks)

If yes, please explain:

*Have you ever been convicted of a crime or entered a pretrial diversion program to avoid a conviction?

Yes  No

If yes, please list:

*Position applying for:

*Pay expected:

*Have you applied for work with us before?

Yes  No

Where?

When?

Where?

When?

*Apart from religious services, will you be able to work all other times?

Yes  No

(If hired, you will be required to perform work as required by the credit union.)

*Who referred you to us?

Relative

Employment Agency

Newspaper Ad

Friend

State Employment Office

College Placement Service

Walk in

Other

*High School:

Major:

Years There:

Technical School:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

College:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

College:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

Graduate School:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

Other:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

Starting with your present or last job, provide complete employment history for the last 10 years. You must answer all questions and this employment history must be completed even if you submit a resume.

1. Name of Employer:

Phone Number:

Phone Number Area Code( ) Phone Number Part 1 - Phone Number Part 2 Phone Number Extensionext:

Employer Address:

Employer Address Street

Employer Address City

Employer Address State

Employer Address Zip Code

Ending Date of Employment:

Position Title and Duties:

Reason for leaving

May we contact this employer?

Yes  No

If no, explain:

2. Name of Employer:

Phone Number:

Phone Number Area Code( ) Phone Number Part 1 - Phone Number Part 2 Phone Number Extensionext:

Employer Address:

Employer Address Street

Employer Address City

Employer Address State

Employer Address Zip Code

Ending Date of Employment:

Position Title and Duties:

Reason for leaving

May we contact this employer?

Yes  No

If no, explain:

3. Name of Employer:

Phone Number:

Phone Number Area Code( ) Phone Number Part 1 - Phone Number Part 2 Phone Number Extensionext:

Employer Address:

Employer Address Street

Employer Address City

Employer Address State

Employer Address Zip Code

Ending Date of Employment:

Position Title and Duties:

Reason for leaving

May we contact this employer?

Yes  No

If no, explain:

Please provide the names of three persons you are not related to, you have known at least one year and whom we may contact.

*Phone:

Phone Area Code( ) Phone Part 1 - Phone Part 2 Phone Extensionext:

*Yrs. known:

*Phone:

Phone Area Code( ) Phone Part 1 - Phone Part 2 Phone Extensionext:

*Yrs. known:

*Phone:

Phone Area Code( ) Phone Part 1 - Phone Part 2 Phone Extensionext:

*Yrs. known:

*Summarize your job skills, training and/or study that are relevant for the desired position. Also, explain any periods that you were not working.

CERTIFICATION

PLEASE READ CAREFULLY BEFORE SIGNING

By signing below I CERTIFY that all the information provided in this application is true and correct. I acknowledge that providing false or incorrect information or omitting information from this application could be grounds for not being hired for the position or for subsequent discharge from the position if I am hired. I also agree to the background information listed below.

CONSENT TO CONDUCT A BACKGROUND INVESTIGATION

As part of our procedure for processing your employment application your personal and employment references will be checked. FWCCU will also request a copy of your consumer credit report to verify information provided on your employment application. Florida West Coast Credit Union will also require that you are bondable through our bonding company. If you have misrepresented or omitted any pertinent facts on this application, and are subsequently hired, you may be discharged from employment. You may make a written request for information derived from the checking of the references. As a condition of employment it is necessary to provide a completed I-9 which is a DHS Employment Eligibility Verification within 3 business days of your hire date. To complete this form certain identifying documentation will be required from the employee. FWCCU also requires each employee to sign a conflict of interest agreement as well as additional employment agreements regarding the use of the internet and acceptance of employee policies and procedures.

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize Florida West Coast Credit Union and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

I hereby authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish Florida West Coast Credit Union or its designated agents with any and all information in their possession regarding me in connection with an application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.

I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided to me.