Job Application Form

Application for Employment

Please complete and submit your application before leaving this page. Your personal data will be securely encrypted when you submit your application to National Bank. * Indicates required field.

We consider applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, protected veteran status or any other classification protected under applicable law. Equal access to employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify Human Resources.

In order to be considered for employment, this application must be completed in full. Please indicate the specific job title for which you are interested in being considered. Individuals who express an interest in "any" position, or a generic title, will not be considered for employment.

Date

Social Security Number*

First Name*

Middle Name

Last Name*

Home Telephone*

Business Telephone

Are you over the age of 18?*

Yes

Address*

Street/Box Number

City*

State*

Zip Code*

Previous Address

Email:

Have you ever worked under any other name?

Yes

If yes, please state name

Position for which you are applying*

Full Time

Part Time

Temporary

Summer

If part time, please indicate days and hours available

Minimum salary required

When could you start work?*

Have you applied for employment with us before?

Yes

If yes, when

Do you have any relatives, either by birth or marriage, employed by our bank?*

Yes

If yes, please give names

Are you eligible to work in the United States?*

Yes

If you are not a citizen, please state type and number of visa which verifies your legal right to work.

Have you ever been convicted of a felony or of any criminal offense involving dishonesty, breach of trust, or money laundering, which has not been expunged from the record?*

Yes

Have you ever entered a pre-trial diversion program in connection with the prosecution of any of these offenses?*

Yes

If yes, please give dates and explain

Employment History

Beginning with your present or last position, please list your last three jobs. Include a summary of major duties, especially those that might apply to a job with our bank. If you have a resume and/or professional references please attach them to the application below. If you wish to list more than three jobs but do not have a resume, please attach a salary continuation sheet.

Upload Resume

No files have been uploaded yet.

Upload Professional References

No files have been uploaded yet.

Upload Continuation Sheet

No files have been uploaded yet.

Employer Name*

Employment Start Date*

Employment End Date*

Employer Address*

Employer Telephone*

Starting Salary*

Final Salary*

Name of Supervisor*

Your title and major duties*

Why did you leave?*

May we contact employer now?*

Yes

Employer 2 Name

Employment 2 Start Date

Employment 2 End Date

Employer 2 Address

Employer 2 Telephone

Employment 2 Starting Salary

Employment 2 Final Salary

Employment 2 Name of Supervisor

Employment 2 Your title and major duties

Employment 2 Why did you leave?

May we contact employer 2 now?

Yes

Employer 3 Name

Employment 2 Start Date

Employment 3 End Date

Employer 3 Address

Employer 3 Telephone

Employment 3 Starting Salary

Employment 3 Final Salary

Employment 3 Name of Supervisor

Employment 3 Your title and major duties

Employment 3 Why did you leave?

May we contact employer 3 now?

Yes

Have you ever been discharged or forced to resign?*

Yes

If yes, please give reason

If presently employed, why do you wish to change your position?

Educational Background

Name and Location of High School*

Did you graduate from High School*

Yes

Name and Location of College

Did you graduate from College

Yes

Major

Grade Average

No. of Credits

Name of Business or Trade School

Course of Study

Are you planning to pursue further studies?

Yes

If yes, when, where, and what courses?

Do you have any special training, certifications, or skills? Please list computer software with which you have worked.

Describe other interests and aptitudes that would be relevant to a position at our bank. You might want to include licenses, memberships in organizations and professional societies, civic activities, and hobbies. (Please exclude groups which indicate race, color, religion, age, sex, or national origin.)

Please Read Carefully Before Signing

I authorize all educational institutions, present and former employers and law enforcement agencies to supply any information concerning my qualifications and past employment to National Bank. I release them and the bank from all related liability.

All of the statements contained in this application are true and complete, and I realize that misrepresentation or omission of facts will be sufficient cause for cancellation of consideration for employment or dismissal from the bank’s service if I have already been employed.

If I am offered employment, I understand that additional personal data will be required for determination of benefit eligibility and statistical purposes.

Although this application will be given every consideration, its receipt does not imply that an applicant will be employed by the bank.

I HAVE READ AND UNDERSTOOD ALL OF THE ABOVE.

Signature*

Date*

APPLICANT DATA RECORD

Applicants and Employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap/disability, or any other legally protected status.

We comply with government regulations, including affirmative action responsibilities where they apply.

Solely to help us comply with governmental record keeping, reporting and other legal requirements, we request that you please fill out the Applicant Data Record. We appreciate your cooperation.

This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment. YOUR COOPERATION IS VOLUNTARY.

Date*

Position Applied For*

Name*

Last, First, and Middle

Phone*

Address*

Referral Source*

Bank Website

Social Media

indeed.com

Friend/Relative

Employment Agency

Walk In

Other

CONFIDENTIAL INFORMATION
VOLUNTARY SURVEY

Various government agencies request statistical information regarding our hiring practices. Your cooperation in completing this form is completely voluntary. Any information gathered is strictly confidential and will not subject you to coercion or intimidation relating to your status. Failure to provide this information will not adversely affect your application. Thank you for your cooperation.

Check One

Male

Female

Check one of the following Race/Ethnic Groups

Hispanic or Latino

Other

If other, check one of the following Race/Ethnic Groups

White	Two or more Races
Black or African American	Native American Indian/Alaskan Native
Asian	Native Hawaiian or Other Pacific Islander

If Native American Indian, check if any of the following are applicable

Formal member of a particular tribe

Have a membership card issued by the tribe

Have a Certificate of Degree of Indian Blood issued by the Bureau of Indian Affairs

Are considered an American Indian in your community

Used American Indian School or hospital

I am a protected veteran

Yes

Signature of Applicant

Voluntary Self-Identification of Disability

Name

Today’s Date

Employee ID (if applicable)

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes

Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports

Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury

Please check one of the boxes below

Yes, I have a disability, or have had one in the past

No, I do not have a disability and have not had one in the past

I do not want to answer

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

ⁱ Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp, EEO is the Law ,and EEO is the Law Supplement

Fair Credit Reporting Act Notice and Consent

National Bank routinely obtains consumer credit reports for employment-related purposes. The Fair Credit Reporting Act states that we must disclose this fact to you. The Act also requires that we (1) obtain your written consent before we request your credit report; (2) provide you with a copy of the credit report before we take any action which is adverse to your interests, such as failing to offer you employment because of information found in your credit report; (3) provide you with a copy of your rights under the Fair Credit Reporting Act if adverse action is taken.

I understand that National Bank may obtain my consumer credit report for employment-related purposes. My signature indicates that I consent.

Signature*

Date*

Please ignore this field.

* indicates required fields.

Submit

Job Application Form

Application for Employment

Employment History

Educational Background

Please Read Carefully Before Signing

APPLICANT DATA RECORD

CONFIDENTIAL INFORMATION VOLUNTARY SURVEY

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

How do you know if you have a disability?

Reasonable Accommodation Notice

Fair Credit Reporting Act Notice and Consent

CONFIDENTIAL INFORMATION
VOLUNTARY SURVEY