Name (First, Middle, Last, Maiden (if applicable)   Permanent Address    City  State/Province  AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMaineMarylandMassaschusettsMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWashington DCWisconsinWest VirginiaWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNew FoundlandNorthwest TerritoryNova ScotiaOntarioPrince Edwards IslandQuebecSaskatchwanYukon Territory ZIP/Postal Code    Email Address  Telephone Numbers  Day  Evening  Cell  Type of Employment Desired:  Full Time     Part Time   Are you 18 years of age or older? Yes  No  Have you ever been convicted of a criminal offense? Yes  No  Conviction does not necessarily disqualify an applicant from employment.  Failure to respond to any question on the application truthfully automatically disqualifies the applicant.      Education and Training: High School - Name and location Did you graduate? Yes  No  College or University - Name and location Did you graduate? Yes  No   Last Year Completed Degree Major GPA Other pertinent training.  Please describe.  Employment History:  Please give history for at least last 5 years Employer:                               Address:                    Dates of Employment:   Immediate Supervisor: Phone Number:            Your Position:               Reason for leaving:              Employer:                               Address:                    Dates of Employment:   Immediate Supervisor: Phone Number:            Your Position:               Reason for leaving:           Employer:                               Address:                    Dates of Employment:   Immediate Supervisor: Phone Number:            Your Position:               Reason for leaving:      Employer:                               Address:                    Dates of Employment:   Immediate Supervisor: Phone Number:            Your Position:               Reason for leaving:          Please be sure to read the following statements and indicate your acceptance by transmitting to the Credit Union. Do you authorize us to obtain confidential work related performance and credit reports from: Your former employers:  Yes  No  Your present employers:  Yes  No  Credit Reporting agencies:  Yes  No  Please state approximate salary which you expect $ per hour: I do understand proof of citizenship or immigration will be required upon employment. Date available to report for work: It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and /or separation from the employer's service if I have been employed.  Furthermore, I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice.  I understand that no representative of the Employer has the authority to make any assurance to the contrary.  I understand that this application does not represent an offer of, or contract for employment. I give the Employer the right to investigate all references and to secure additional information about me.  If job related; I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.