Application for Employment

BankORION does not unlawfully discriminate in any employment practice on the basis of race, color, age, religion, national origin, sex, veteran status or disability. No question on this application is intended to secure information which could be of a discriminatory nature.

Please

1. Print the form first.

2. Complete the form in your own handwriting.

3. Mail to:

Sharon Warner
Human Resources Director
BankORION
1114 - 4th Street
P.O. Box 9
Orion, IL 61273

APPLICANT INFORMATION
First Name   Middle Initial   Last Name
Present Address    State    ZIP Code                             
Home Phone  Work Phone 
Previous Address  State  Zip                             
Social Security #  May we contact you at your present employer?
Yes    No
Position Applying for Salary Desired 
Referred by  Date Available for Work
Are You Available to Work: (Check all that apply.)
Full Time             Part-Time           Temporary         Shift Work
Will you work overtime if required? Yes    No
Are you legally eligible to work in the United States? Yes    No
Have you been bonded? Yes    No
Have you ever applied here before? Yes    No
If Yes, which location?
Have you been employed here previously? Yes    No

If Yes, give dates 
If Yes, which Location?
Do you have a relative who works here? Yes    No
Have you ever been convicted of a felony?
Note: A "yes" answer to this question will not necessarily result in your application being denied.		 Yes   No
Were (are) you in the U.S. Armed Forces? Yes   No
If Yes, w hich branch?

EMPLOYMENT HISTORY

Company Name Phone
Address Employed from (Mo/Yr) to (Mo/Yr)  
Name of Supervisor/Title  Starting Hourly Rate/Salary
Final
Your title/job duties Reason for leaving
 
Company Name Phone
Address Employed from (Mo/Yr) to (Mo/Yr)  
Name of Supervisor/Title Starting Hourly Rate/Salary
Final 
Your title/job duties Reason for leaving
  
Company Name Phone
Address Employed from (Mo/Yr) to (Mo/Yr)  
Name of Supervisor/Title Starting Hourly Rate/Salary
Final 
Your title/job duties Reason for leaving
    
Company Name Telephone Number
Address Employed from (Mo/Yr) to (Mo/Yr)  
Name of Supervisor/Title Starting Hourly Rate/Salary       
Final 
Your title/job duties Reason for leaving
 
If presently employed, why do you desire to change positions?
If presently employed, may we contact your current employer? Yes    No

EDUCATION
High School Name Address
Course of Study Dates Attended
Did you Graduate?    Yes    No Diploma or Degree
College Name Address
Course of Study Dates Attended
Did you Graduate?    Yes    No Diploma or Degree
Other Educational Institution Address
Course of Study Dates Attended
Did you Graduate?    Yes    No Diploma or Degree
List any scholastic honors, offices held, and activities in High School:
List any scholastic honors, offices held, and activities in College:
Do you have any plans for further education?    Yes    No
If yes, explain:

Optional:
Are there any special skills you would like to include that you feel might better qualify you for the job. (You may wish to include civic and community activities, professional societies or special training such as typing, accounting, etc.) Do not include information which would reveal sex, race, color, age, national origin, religion, veteran status or disability.

Please select the level of fluency  with foreign languages, if any?

Language  speak           read           write
Language  speak           read           write

 

 
REFERENCES
Reference 1:
Reference 2:
Reference 3:
Reference 4:

PLEASE READ CAREFULLY BEFORE SUBMITTING THE APPLICATION.

(If you have any questions regarding this statement, please ask a representative of the Human Resources Office before signing.)

PRE-NOTIFICATION OF BACKGROUND INQUIRY

I hereby authorize any and all law enforcement agencies to release a copy of any arrest record that I may have to BankORION or it's agent, Trans Union Corporation.  By doing so, I release any law enforcement agency and all individuals connected therewith from any and all liability.

This inquiry likely will concern itself with any and all of the following:  An applicant's criminal history (if any), driving record, and/or prior work history.  BankORION reserves the right to consider an inquiry of this type to be made at a future date, should you remain in our employ.  In any instance, when an inquiry of the type is made, now or in the future, the scope, nature and results of such inquiry will be made available to the applicant upon written request.

I also understand that an inquiry into my credit history will be conducted.  I further acknowledge receipt of the notice entitled, "A Summary of Your Rights Under the Fair Credit Reporting Act."

A photocopy of this authorization and release shall be considered as effective and valid as the original.

I hereby authorize BankORION to make the above inquiries.

I hereby acknowledge that I have read and understand the preceding statements.

_________________________________________________
Signature                                                  Date