Employment Application

Gerber Federal Credit Union is an equal opportunity employer and does not discriminate against otherwise qualified individuals on the basis of age, gender, race, religion, color, national origin, disability, martial status, height and weight, veteran status (including veterans of the Vietnam era) or any other legally protected status.

You must complete the entire application and sign the Authorization and Understanding at the end of the application to be considered for employment, even if you have submitted a resume. If there is not enough space on this form to answer a question fully, please attach additional pages.

PERSONAL INFORMATION
First Name	Middle Initial	Last Name

Present Address

City	State	Zip

Previous Address

City	State	Zip

Social Security Number	Email

Home Phone	AlternatePhone
() -Second partThird part	() -Second partThird part
List any other names you have used in school or at any previous job	Are you legally authorized to work in the United States
	YesNo

Employment Desired
Position applied for		Type of employment desired

If part time, specify days and hours available

Salary expected	Date available to begin work	How were you referred to Gerber Federal Credit Union?

Have you ever applied here before or been employed here before?		If yes, specify dates

Are any of your friends or relatives employed at Gerber Federal Credit Union?		If yes, specify
YesNo
Are you 18 years of age or older?		If under age 18, can you supply work permit?
		YesNo
Have you ever been bonded?		If yes, on what jobs?
YesNo
Have you ever been convicted of any crime excluding routine traffic offenses?		If yes, describe in detail.
YesNo

Education
High School
Name and Address	Did you Graduate?	Course of Study or Degree Completed

College	Did you Graduate?	Course of Study or Degree Completed

Other	Did you Graduate?	Course of Study or Degree Completed

Are you attending school now or do you plan on furthering your education?		If yes, please specify course and time commitment.
YesNo
Do you hold any professional licenses or certifications?		If yes, please list and describe.
YesNo
Have you ever had a professional license/certification revoked or suspended?		If yes, please list and describe.

Are you currently under investigation by any agency or department concerning a licensure or certification matter?		If yes, please describe.
YesNo
List other experiences, skills or qualifications you believe especially qualify you to work for Gerber Federal Credit Union

Employment History
Employer One:
Start with most recent; include your entire employment history and military service.
Start Date	End Date

Employer	Address (street, city, state & zip)

Work Phone	Job Title
() -Second partThird part
Supervisor Name & Title	Reason for Leaving

Summarize the nature of work performed and job responsibilities

Starting Hourly Rate/Salary	Ending Hourly Rate/Salary

Employer Two:
Start Date	End Date

Employer	Address (street, city, state & zip)

Work Phone	Job Title
() -Second partThird part
Supervisor name & title	Reason for Leaving

Summarize the nature of work performed and job responsibilities

Starting Hourly Rate/Salary	Ending Hourly Rate/Salary

Employer Three:
Start Date	End Date

Employer	Address (street, city, state & zip)

Work Phone	Job Title
() -Second partThird part
Supervisor name & title	Reason for Leaving

Summarize the nature of work performed and job responsibilities

Starting Hourly Rate/Salary	Ending Hourly Rate/Salary

Employer Four:
Start Date	End Date

Employer	Address (street, city, state & zip)

Work Phone	Job Title
() -Second partThird part
Supervisor name & title	Reason for Leaving

Summarize the nature of work performed and job responsibilities

Starting Hourly Rate/Salary	Ending Hourly Rate/Salary

Are you currently employed?	If yes, how much notice would you need to give to current employer?	May we contact your current employer for a reference?

Have you ever been discharged or asked to resign from a job?	If yes, please provide explanation:
YesNo

References
Reference 1
Please provide the following information of people who know you (other than previously listed and excluding relatives).
Name	Address	Phone Number
		() -Second partThird part
Relationship	Years Known

Reference 2
Name	Address

Phone Number	Relationship	Years Known
() -Second partThird part
Reference 3
Name	Address

Phone Number	Relationship	Years Known
() -Second partThird part

AUTHORIZATION and UNDERSTANDING

I certify that the answers and information given by me in this application are true and complete to the best of my knowledge. I authorize Gerber Federal Credit Union to verify the information I have provided and to make any investigation of my background it believes necessary. I also authorize third parties (such as former employers, law enforcement organizations, financial institutions, educational institutions) contacted by Gerber Federal Credit Union to furnish any information relevant to may application for employment, excluding health or medical history or other illegal information, and waive any applicable notice requirement. I release all persons and organizations from any and all liability and any and all damages whatsoever for furnishing such information.

If employed, I agree to sign any requested non-compete, non-disclosure, non-solicitation and/or confidentiality agreement. I further agree not to disclose the trade secrets or confidential information of third parties to Gerber Federal Credit Union at any time. If I have executed a non-compete or similar agreement with my current employer or any prior employer, I have informed Gerber Federal Credit Union of the substance of that agreement. I consent to all legally permissible medical examinations and drug and alcohol testing required by Gerber Federal Credit Union.

I understand and agree that employment with Gerber Federal Credit Union is at-will and that either I or Gerber Federal Credit Union can terminate my employment and compensation, for any reason, and with or without notice, at any time. I acknowledge that no representations, either oral or written, have been made to me to the contrary and that any pre-existing understandings which contradict an at-will status of employment are canceled. Further, I understand that only the President/CEO of Gerber Federal Credit Union has any authority to enter into any agreement for employment for any fixed period of time, or to make any agreement contrary to the foregoing and that any such agreement must be in writing and signed by the President/CEO of Gerber Federal Credit Union.

In consideration of my employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I agree to conform to the rules and policies of Gerber Federal Credit Union. Also, I agree not to begin any action or suit relating to employment with Gerber Federal Credit Union more than six (6) months after the date of termination of such employment and I waive any statuette of limitations to the contrary. If this provision is held invalid or unenforceable, I agree that such time period will be deemed increased to the minimum extent necessary to make such provision valid and enforceable.

I understand that completion of this application for employment does not guarantee that I have been employed or will be employed by Gerber Federal Credit Union.

This application for employment shall be considered active for a period of time not to exceed sixty (60) days. If I wish to be considered for employment beyond this time period, I will inquire as to whether or not applications are being accepted at that time.

If any term of this document is found to be legally unenforceable as written, it can be modified to permit enforcement as far as legally possible.

Submitting this application indicates that I have read and understood the above paragraphs.

Electronic Signature and Agreement

I have read the above statements and indicate my level of acceptance of each of its terms as:

Yes - I fully agree with the above statements and authorize you to verify my application
No - I do not fully agree with the above statements and do not authorize any further investigation

Applicant's Electronic Signature (re-type full name)

Attach Resume

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