Applicant Name *
Applicant Name
Date of Application *
Date of Application
Applicant’s Address *
Applicant’s Address
Telephone *
Telephone
Business telephone where you can be reached
Business telephone where you can be reached
May we contact you there?
Status Desired *
Referral Source *
Are you willing to travel? *
Are you willing to work overtime? *
Date Available for Work *
Date Available for Work
Are you 18 years of age or older? *
Are you 18 years of age or older? *
Proof of citizenship or immigration status will be required upon employment
(List each job held. Start with your present or last job. Include military service assignments and volunteer activities.) Date From Employer Name Employer Address Date To Employer Phone Number Job Title Supervisor Reason for Leaving Work Performed May we contact: Yes/No Are you known by another name> Yes/No If yes, What name?
Name and Title Address/Phone Number
High School (Name/Address of School, Course of Study, Graduated?, Diploma/Degree) College (Name/Address of School, Course of Study, Graduated?, Diploma/Degree) Other (Name/Address of School, Course of Study, Graduated?, Diploma/Degree)
Are you known to schools by another name?
Pre-Employment Statement
I represent that my responses set forth in this application are truthful, accurate, and complete. Any and all false or inaccurate statements made by me in this Application or otherwise during the employment evaluation process shall be grounds both for rejecting my Application for employment and, should I be hired by Community Credit Union, termination of my employment. I authorize representatives of Community Credit Union to contact educational institutions and employers designated in this Application for purposes of verification and investigation of my educational and employment background and performance. Such individuals and organizations are authorized to release such information as may be requested by a Community Credit Union representative. I hereby release all such persons from liability or damages incurred as a result of furnishing such information. I understand that an unsatisfactory reference shall be grounds both for rejecting my Application for employment and, should I be hired by Community Credit Union termination of my employment. Should I be employed by Community Credit Union, I understand that I could be subject to an outside probe if accused of wrongdoing. Please be aware that Community Credit Union is required to report New Hire information in Maine to the State of Maine, Department of Human Services, Division of Support Enforcement and Recovery weekly or within 7 days of the date of hire or rehire. Community Credit Union complies with this legal requirement. Submission of the application does not entitle me to be interviewed by Community Credit Union. Further, nothing in this Application or in the employment evaluation process shall be construed as either an offer of employment or an obligation on the part of Community Credit Union to provide any benefit to me. This Application shall be pending, unless withdrawn by me, until Community Credit Union makes a decision on whether or not to hire me or until the 60th day after submission of this application to Community Credit Union, whichever occurs first. If no action is taken on my Application within a 60-day period, I understand that I must re-apply to Community Credit Union in order to be considered for employment. Should I be employed by Community Credit Union, I agree to comply with any and all employment rules and policies of Community Credit Union. After reading all of the terms of this application. I hereby affirm that I understand and agree to the provisions of the same. I also agree that my employment with Community Credit Union is on an “at-will” basis, meaning that such employment may be permanently discontinued by either Community Credit Union (through discharge or lay/off) or myself through voluntarily quitting at any time without notice and without any recourse of any kind by either party. I expressly agree and understand this is the entire agreement between Community Credit Union and me on the subject of discharge, termination and/or layoff, and it may be changed only by an agreement in writing signed by the President of Community Credit Union. I agree to conform to Community Credit Union’s rules and I also agree that I shall be subject to other conditions, which Community Credit Union may adopt. I affirm the information in this application is true and complete, and any intentional deception herein may be considered sufficient cause for dismissal.
Please check the box below to agree to the above statement *
Consumer Report Release Statement
Community Credit Union (the “Company”) will order an investigative report (background check report) and/or a consumer report on you (if applicable) in connection with your application for employment. I the undersigned person hereby authorize that by consumer report be released. The consumer reporting agency (“Consumer Reporting Agency”) that will prepare and process the report(s) is: CBC Innovis PO Box 1667 Pittsburgh, PA 15230 (877) 237-8317 Transunion 2 Baldwin Place, P.O. Box 1000 Chester, PA. 19022 800-888-4213 In the event of any adverse action being taken against me in whole or in part based upon information obtained from my consumer report, I understand that I have the following rights under the Fair Credit Reporting Act: (1) CBC Innovis, shall provide me with a copy of the report free of charge; (2) Community Credit Union shall provide me with a description in writing of my rights under the Fair Credit Reporting Act as prescribed by the Consumer Financial Protection Bureau (CFPB) www.consumerfinance.gov/learnmore">www.consumerfinance.gov/learnmore If you live or work for the Company in the states listed below, please note the following: MAINE: If you ask Community Credit Union, you have the right to know whether the Company ordered an investigative consumer report on you. You may request the name, address, and telephone number of the nearest office for CBS Innovis. You will get this information within 5 business days of our receipt of your request. You have the right to ask CBC Innovis for a free copy of the report. We may procure or request preparation of an investigative consumer report as part of our procedure for processing your employment application. Note: Consumer reports (credit reports) may be obtained in connection with this application. If you request: 1. You will be informed whether or not consumer reports were obtained. 2. If reports were obtained, you will be informed of the names and addresses of the consumer reporting agencies (credit bureaus) that furnished the reports. An investigative consumer report is a report whereby information is obtained through personal interviews with your neighbors, friends or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics and mode of living.
I agree that a facsimile or photocopy of this form is valid just like the original form. I acknowledge that I have read, understand and agree to the above information. *