* Indicates Required. If a field does not apply to you, enter N/A or 0.

• 
  

  Bank of Pontiac is an equal opportunity employer. Bank of Pontiac does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.

  Applicant Information

  Incomplete information could disqualify you from further consideration. Please complete all fields.

  Your Name

  First Name *

  Last Name *

  Street Address*

  Apartment/Unit

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip*

  Email*

  Home Phone #*

  Mobile Phone #*

  Are you eligible to work in the US? *

  Yes No

  Are you eligible to work in the US? is required

  Are you 18 or older? *

  Yes No

  Are you 18 or older? is required

  Have you ever been terminated from employment or asked to resign by an employer? *

  Yes No

  Have you ever been terminated from employment or asked to resign by an employer? is required

  Company Name *

  Details *

  Can you work any shift? *

  Yes No

  Can you work any shift? is required

  Details *

  Shift preferred *

  1 2 3 Any

  Shift preferred is required

  Can you work overtime, including weekends? *

  Yes No

  Can you work overtime, including weekends? is required

  Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)?*

  Yes No Need more information about the job's essential functions to respond.

  Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)? is required

  This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

  Employment Desired

  On what date would you be available for work? *

  Hourly rate/Salary Desired*

  Position Desired *

  Are you currently employed? *

  Yes No

  Are you currently employed? is required

  May we inquire of your present employer? *

  Yes No

  May we inquire of your present employer? is required

  Referral Source

  How did you hear about us? *

  Walk In Advertisement Referral Other

  How did you hear about us? is required

  Have you ever worked for this company before? *

  Yes No

  Have you ever worked for this company before? is required

  Explain *

  Do you know anyone who works for our company? *

  Yes No

  Do you know anyone who works for our company? is required

  Who? *

• Education

  High School

  High School Name *

  Completed *

  Diploma Degree Certification GED Other I Did Not Complete This Education

  Completed is required

  College or University

  College or University Name *

  Address *

  Address Line 2

  City *

  State *

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip *

  Completed *

  Diploma Degree Certification GED Other I Did Not Complete This Education

  Completed is required

  Degree *

  Certification *

  Other *

  Major/Minor *

  Trade, Business or Correspondence School

  Trade, Business or Correspondence School Name *

  Address *

  Address Line 2

  City *

  State *

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip *

  Completed *

  Diploma Degree Certification GED Other I Did Not Complete This Education

  Completed is required

  Degree *

  Certification *

  Other *

  Major/Minor *

• Employment History

  Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

  Previous Job 1

  Employed From *

  To *

  Employer Name *

  Phone *

  Address *

  City *

  State *

  Alabama Alaska Arizona Arkansas Cadivfornia Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carodivna North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carodivna South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip *

  Job Title *

  Summarize the type of work performed and job responsibilities. *

  Immediate Supervisor *

  Why did you leave? *

  Have you worked at another job within the past 2 years?*

  Yes No

  Whether you have another previous employment is required

  Previous Job 2

  Employed From *

  To *

  Employer Name *

  Phone *

  Address *

  City *

  State *

  Alabama Alaska Arizona Arkansas Cadivfornia Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carodivna North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carodivna South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip *

  Job Title *

  Summarize the type of work performed and job responsibilities. *

  Immediate Supervisor *

  Why did you leave? *

  Have you worked at another job within the past 2 years?*

  Yes No

  Whether you have another previous employment is required

  Previous Job 3

  Employed From *

  To *

  Employer Name *

  Phone *

  Address *

  City *

  State *

  Alabama Alaska Arizona Arkansas Cadivfornia Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carodivna North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carodivna South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip *

  Job Title *

  Summarize the type of work performed and job responsibilities. *

  Immediate Supervisor *

  Why did you leave? *

• References

  Give the names of three persons not related to you, whom you have known at least three (3) years.

  Reference 1

  Full Name*

  Relationship *

  Company *

  Phone *

  Address*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip*

  Reference 2

  Full Name*

  Relationship *

  Company *

  Phone *

  Address*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip*

  Reference 3

  Full Name*

  Relationship *

  Company *

  Phone *

  Address*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip*

  Agreement

  Please read carefully before signing.

  I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Bank of Pontiac to hire me. If I am hired, I understand that either Bank of Pontiac or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Bank of Pontiac has the authority to make any assurance to the contrary.

  I attest with my signature below that I have given to Bank of Pontiac true and complete information on this application. No requested information has been concealed. I authorize Bank of Pontiac to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

  I agree with the above terms, and that by checking this box am considered to have provided my legally binding signature.*

  Your agreement to the terms is required.

  Date*