Applicant Info
Position
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Full-Time Banker (Pittsfield)
Part-Time Banker Float (Pittsfield)
Part-Time Banker Float (White Hall)
Loan Assistant (Pittsfield)
Internship
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How Did You Learn About Us?
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Farmers State Bank Employee
Employee Name
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Name
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Zip
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Telephone Number
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Mobile/Other Phone Number
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E-mail Address
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Have you ever filed an application with us before?
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No
If yes, please give date
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Have you ever been employed with us before?
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Are you currently employed?
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If so, where
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May we contact your present employer?
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On what date would you be available for work?
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Are you currently on lay-off status and subject to recall?
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Have you ever been convicted of a felony?
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No
If yes, please provide date of conviction and a description of what conviction was for.
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If yes, are you capable of performing in a reasonable manner the activities in the job or occupation for which you have applied based on the job posting?
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Have you read the job description/posting giving the requirements of the job for which you are applying?
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Education
High School
Name and Location of School
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Course of Study
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Years Completed
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Diploma Degree
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Undergraduate College
Name and Location of School
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Course of Study
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Years Completed
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Diploma Degree
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Graduate Professional
Name and Location of School
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Course of Study
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Years Completed
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Diploma Degree
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Other (Specify)
Name and Location of School
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Course of Study
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Years Completed
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Diploma Degree
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Professional Organizations
List Professional, Trade, Business or Civic Activities and Offices Held
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.
Describe any specialized training, apprenticeships, skills, extra-curricular activities, job-related training received in the United States military or qualifications acquired from employment or other experience.
Professional, Trade, Business or Civic Activities and Offices Held
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Specialized Skills
Word
WordPerfect
Lotus 1-2-3
Excel
Access
PowerPoint
Calculator
Keyboarding
Fax
Do you hold any State Certificates or Licenses?
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No
If yes, please list
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State any other additional information which you feel may be helpful to use in considering your application
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Employment Experience
Start with your present or most recent job. Include any job-related military service assignment and volunteer activities. You may exclude employment which would reveal gender, race religion, national origin, age, ancestry, disability, or other protected status.
Most Recent Position
Employer
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Zip
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Phone
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Job Title / Supervisor
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From
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To
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Full-time
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Work Performed
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Reason for Leaving
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May we contact this employer for references?
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Previous Position
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Zip
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Phone
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From
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To
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Full-time
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Work Performed
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Reason for Leaving
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May we contact this employer for references?
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Previous Position
Employer
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Address
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Zip
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From
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Work Performed
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Reason for Leaving
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May we contact this employer for references?
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Previous Position
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Zip
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Phone
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From
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To
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Full-time
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Work performed
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Reason for leaving
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May we contact this employer for references?
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References
Reference 1
Name
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Address
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Tennessee
Texas
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Washington
West Virginia
Wisconsin
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Zip
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Reference 2
Name
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Phone
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Address
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City
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New York
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Ohio
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Tennessee
Texas
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Washington
West Virginia
Wisconsin
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Zip
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Reference 3
Name
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Phone
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Address
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City
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State
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Nebraska
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New Jersey
New Mexico
New York
North Carolina
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Ohio
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Washington
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Wisconsin
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Zip
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Voluntary Survey
Government agencies at times require periodic reports on the sex, ethnicity, disability, veteran and other protected status of employees. This data is for statistical analysis with respect to the success of the Affirmative Action program.
SUBMISSION OF THE FOLLOWING INFORMATION IS VOLUNTARY
Date
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Name
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Address
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Current Job
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Male
Female
Ethnicity (check one of the following)
White
Native Hawaiian or other Pacific Islander
Hispanic or Latino
Asian
American Indian/Alaskan Native
Black or African American
Two or more races
Other
Check if any of the following are applicable
Vietnam Era Veteran
Disabled Veteran
Disabled Individual
Veteran
Birthdate
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Resume
OPTIONAL: Please upload a copy of your resume. (PDF file please)
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