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.

Screening tests for illegal drug use may be required before hiring and during your employment here.

PERSONAL INFORMATION

Date of Application

First Name

Middle Initial

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Are you 18 years old or older?

Are you legally eligible to work in the U.S. for an U.S. employer?

YesNo

If offered employment, you will be required to provide documentation to verify eligibility.

Have you ever been covered by a surety bond?

Have you ever been denied a surety bond or had such coverage revoked?

If yes to either, state dates and reasons:

YesNo

Have you ever applied here before?

If yes, specify dates:

Have you been employed here before?

If yes, specify dates:

If previously employed here, name under which employed, if different:

Previous Position:

Reason for leaving:

List any friends or relatives, other than a spouse, already employed here:

Are your employment or school records listed under another name? If yes, please specify:

Employment Desired

Position(s) applied for
(please be specific, do not say "any"):

Type of employment desired:

Availability:

Expected Pay:

Date available to begin work:

Please indicate experience and skills that relate to the position(s) applied for:

Education

High School

Name and Address:

Number of Years Completed:

Did you Graduate?

List Diploma or Degree:

College

Number of Years Completed:

Name and Address:

Did you Graduate?

List Diploma or Degree:

Other

Number of Years Completed:

Name and Address:

Did you Graduate?

List Diploma or Degree:

Do you hold any professional licenses or certifications?

If yes, please list and describe:

YesNo

Employment History

List below all present and past employment, beginning with your most recent, and attach resume.

Employer One:

Start Date

End Date

Job Title

Employer

Address (street, city, state & zip)

Type of Business

Phone Number

Fax Number

Supervisor Name & Title

Reason for Leaving

Describe the work you did:

Employer Two:

Start Date

End Date

Job Title

Employer

Address (street, city, state & zip)

Type of Business

Work Phone

Fax Number

Supervisor Name & Title

Reason for Leaving

Describe the work you did:

Employer Three:

Start Date

End Date

Job Title

Employer

Address (street, city, state & zip)

Type of Business

Work Phone

Fax Number

Supervisor Name & Title

Reason for Leaving

Describe the work you did:

Employer Four:

Start Date

End Date

Job Title

Employer

Address (street, city, state & zip)

Type of Business

Work Phone

Fax Number

Supervisor Name & Title

Reason for Leaving

Describe the work you did:

You must attach a separate sheet if you have been employed by any employer not listed above.

May we contact your current employer?

May we contact past employers listed?

If not, please indicate the one(s) that you do not want us to contact:

Have you ever been discharged or asked to resign from any position?

If yes, please provide explanation:

YesNo

Military

Have you had any experience in the Armed Forces of the United States?

If yes, what branch?

YesNo

Discharge Date:

Rank at discharge?

List any special training:

References

Do not list relatives or former employers.

Reference 1

Name

Address

Phone Number

Years Known

Reference 2

Name

Address

Phone Number

Years Known

Reference 3

Name

Address

Phone Number

Years Known

How did you hear of an open position here?

Accommodation of Disability

Can you perform the essential job functions of the position(s) for which you are applying, with or without reasonable accommodation?

Please describe the accommodation, if any, that you believe is needed:

YesNo

Emergency Contact

Name and address of person to be notified in case of emergency or accident:

Name

Relationship

Address

Home Phone

Alternate Phone Number

Criminal Record

For Michigan Applicants Only: Have you ever been convicted of or have pleaded “no contest,” “nolo contendre,” or “guilty” to a crime (felony or misdemeanor), including a criminal or vehicular misdemeanor or felony, driving under the influence of alcohol or drugs, or military court martial, but excluding minor traffic offenses, for example, traffic tickets, that has not been judicially ordered sealed or expunged or statutorily eradicated?

YesNo

If yes, when, where, nature of offense, and sentence:

(A conviction will not automatically bar you from employment. Each conviction will be evaluated on its own merits with respect to the offense, the date of the conviction, and the sentence imposed. All circumstances will be considered, including your age at the time of the offense, the date of the offense, the seriousness of the offense, and the job for which you are applying.)

Are there any felony charges currently pending against you?

YesNo

AUTHORIZATION and UNDERSTANDING

Applicant’s Authorization and Acknowledgment of Condition.

Please read carefully and sign below.

Truthfulness of Information

I certify that the answers given by me on this application are true, correct and complete, to the best of my knowledge. I understand that any misstatement, misrepresentation, or omission of facts on this application or any documents used to obtain employment may result in rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery of the misstatement or omission. I further certify that I, the applicant, have personally completed this application.

Authorization of Disclosures

I authorize Gerber FCU to investigate my references, prior employment, work record, education and other matters related to my suitability for employment and, further, authorize the references that I have listed, all prior employers, and all educational institutions attended, to disclose to Gerber FCU any letters, reports, and other information related to my records, including, but not limited to, my performance reviews and evaluations, discipline, commendations, awards, and all other employment information, without giving me prior notice of such disclosure. I understand and agree that they may express their opinions about me and my past or future performance. By providing this page of the application to the references, prior employers, and educational institutions attended, I release them, and their employees, managers, executives, board members, agents, or other representatives, to the fullest extent permitted by law, from any claims and liabilities for providing Gerber FCU with all information, and I release Gerber FCU and its employees, managers, executives, board members, agents or other representatives, to the fullest extent permitted by law, from any and all claims, and liabilities that may result from any use or disclosure of such information by Gerber FCU or any of its employees, managers, executives, board members, agents, or other representatives.

At-Will Employment

If hired, I agree that Gerber Federal Credit Union can terminate my employment and compensation at its will for any reason or no reason, except an illegal reason, with or without cause, at any time, with or without advance notice or warning, and that Gerber FCU’s decision is not subject to review outside Gerber FCU (except as may be provided by applicable statute). I understand and agree that no employee, manager, executive, agent, board member, or any other representative of Gerber FCU, other than the President/CEO, has authority to enter into any agreement for employment for any specified period of time or terminable for cause or to make any oral or written representation or agreement or to establish any practice of contrary to at-will nature of my employment relationship with Gerber FCU I further understand and agree that only an agreement in writing expressly for the purpose of modifying the at-will nature of my employment and signed by me and the President/CEO of Gerber FCU can modify the at-will nature of my employment. I understand and agree that no other oral or written statement, policy, or practice and no provision of Gerber FCU’s employee handbook can change the at-will nature of my employment.

I understand and agree that, by signing this application, I would be accepting employment, if hired, on the terms set forth in this application and that my acceptance of such employment would supersede, revoke, cancel, and negate any prior statements, agreements, practices, policies, and representations, oral or written, if any, that Gerber FCU would employ me on any terms other than the terms set forth in this application.

Limitations on Litigation

In consideration of my employment, if hired, I agree:

That any controversy or claim arising out of this application or my employment with Gerber FCU, or the termination of that employment, including, but not limited to, any claim of discrimination, retaliation or harassment or any other any claim under any state or federal civil rights statute or common law, shall be settled solely by arbitration in the County of Newaygo, State of Michigan, in accordance with the rules of the American Arbitration Association then pertaining. The decision of the Arbitrator shall be final and binding and neither party shall have any right of appeal therefrom. Judgment upon the award rendered by the Arbitrator may be entered in the Circuit Court for the County of Newaygo.
The demand for arbitration must be submitted, in writing, to the Credit Union and to the American Arbitration Association at 1101 Laurel Oak Road, Suite 100, Voorhees, NJ 08043. The demand must be received by the American Arbitration Association within one hundred eighty (180) days after the alleged violation, misconduct, breach or incident which gives rise to the request for arbitration. Failure to file the demand with the American Arbitration Association within the said one hundred eighty (180) day time period shall constitute a full and complete waiver of the claim, and a complete waiver of any right to compensation, benefits or damages. If the written demand for arbitration is not filed within the said one hundred eighty (180) day period, it is forever barred. The parties shall bear their own attorney’s fees associated with the arbitration except as otherwise provided by paragraph 2 of this Agreement.
I am waiving my right to adjudicate claims against the credit union in court, and that I am opting instead to arbitrate any such claims.

Documentation and Certification of Authorization to Work in USA

I certify that I am legally authorized to work in the United States for any U.S. employer. I understand that any offer of employment is conditional upon my ability to provide documents required by the Immigration Reform and Control Act of 1986 proving both my identity and authorization to work in the United States, and that failure to provide documents proving both my identity and authorization to work in the United States, and that failure to provide those documents will result in revocation of the offer or the termination of employment. I certify that I am able to provide documents that demonstrate my identity and work authorization and that I will assist Gerber FCU in completing Form I-9 Employer Verification.

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 (type full name)

Attach Resume

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