Chessie Federal Credit Union

Employment Application


Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, or marital status, or the presence of a non-related medical condition or disability. All questions must be answered and application signed. Any application that provides unrequested information will be automatically rejected.

Position(s) Applied for
Date of Application
First
Last
Middle
Social Security Number
Address
City
State
Zip Code
Address
City
State
Zip Code
How long at this address?
Phone Number
Best time to call you at home
Date Available
Full Time Part Time Temporary Seasonal (check all that apply)
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
(give date, location, charge, etc.)
(Conviction will not necessarily disqualify you for employment)
 Yes No
Driver's License Number
Type
State of Issue
 Yes No
 Yes No
 Yes No
Relationship
First
Last
Middle
Address
City
State
Zip Code

Educational Background

Name
City
How Many Years Attended
 Yes No Graduated
Course or Major
Name
City
How Many Years Attended
 Yes No Graduated
Course or Major
Name
City
How Many Years Attended
 Yes No Graduated
Course or Major
Name
City
How Many Years Attended
 Yes No Graduated
Course or Major
Name
City
How Many Years Attended
 Yes No Graduated
Course or Major

Employment History

List your last three (3) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in comments section below.
Phone Number
Address
City
State
Zip Code
Job Start Date
Job End Date
Job Title
Job Title
$ Gross Salary
Per
$ Gross Salary
Per
 Yes No Later
Phone Number
Address
City
State
Zip Code
Job Start Date
Job End Date
Job Title
Job Title
$ Gross Salary
Per
$ Gross Salary
Per
 Yes No Later
Phone Number
Address
City
State
Zip Code
Job Start Date
Job End Date
Job Title
Job Title
$ Gross Salary
Per
$ Gross Salary
Per
 Yes No Later

References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you, whom have knowledge of your work ethic, experience and abilities.
Name
Telephone
Years Known
Relationship
Name
Telephone
Years Known
Relationship
Name
Telephone
Years Known
Relationship
I certify that the facts contained in this application are true and complete. Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date.

I understand that, if employed, my employment is not guaranteed for any term, and my employment may be terminated by the employer or myself at any time and for any reason with or without prior notice. No representative of Chessie FCU other than the owner(s) is authorized to make any assurance or promise of continued employment and any such assurance must be in writing signed by the owner(s).

If I am employed, I agree to comply with and be bound by the safety and health rules and regulations, and rules of conduct of Chessie FCU.

This application will remain on active file for 60 days. If I am hired within this period, this form will be transferred to my individual personnel file. If I am not hired or have not heard from this employer within 60 days, this application is no longer active and I will need to reapply for employment if I wish to be considered for a job with Chessie FCU.

I give the employer and /or it's agents, including consumer reporting bureaus, the right to investigate any and all statements made in this application for the purpose of employment and retention of employment. This investigation may include, but not limited to, credit reports, criminal conviction records, motor vehicle driving records and previous employment history. Further, I hereby release from liability and hold harmless this employer, its' representatives, all persons and organizations/companies for furnishing such information.

If required, I agree to a drug testing prior and during employment or for post accident occurrences.

The employer, Chessie FCU, is an Equal Opportunity Employer. The employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law.

NOTICE: This is to inform you that as part of processing your employment application, we may obtain a consumer report and/or an investigative report which includes information as to your character, general reputation, personal characteristics and mode of living. If an investigative report is requested, you have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation. By signing below, you acknowledge receipt of a copy of this notice and a copy of the "Summary of Your Rights Under the Fair Credit Reporting Act."
Electronic Signature
Date