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Application for Position: Member Relationship Representative, Part Time, Fairview

INSTRUCTIONS: Please complete all portions of this employment application to be considered for employment. If you require accommodation during the employment process, including assistance in the completion of this employment application, please let us know. We are an equal opportunity employer. We do not discriminate on the basis of age, race, sex, religion, color, national origin, ancestry, marital status, disability, sexual orientation, arrest and court record or any other protected category recognized by state and federal laws. This employment application is valid for a twelve (12) month period after submission to the credit union. Consideration for employment after the twelve (12) month period requires completion and submission of a new application.

PERSONAL INFORMATION:

*Last Name
*First Name
Middle Name
*Street
*City
*State
*Zip Code
*Home Phone
() - ext
*Cell Phone
() - ext
*County
*Email
*Are you 18 years of age or older?  

If no, state your age:
*Are there any hours or days you cannot or will not work?  

If yes, explain:
*Are you willing to work overtime if requested?  

If yes, explain:
*Are you able, upon employment, to submit verification that you are a United States citizen or are eligible to work in the United States?

The Immigration Reform and Control Act (IRCA) requires employers to obtain original documentation from every employee which verifies identity and authorizes employment in the United States

 

POSITION APPLIED FOR:

*Title/Department
*Salary Expectations

*Date Available to Start
*Have you ever been employed with NAFCU before?  

If yes, please provide date, position, and department of employment:
*Does Northland employ any relatives of yours?  

If yes, give name and relationship:
*How did you hear about this position?

EDUCATION:

HIGH SCHOOL

Name / Location of School:
Received:      

COLLEGE / UNIVERSITY / OR PROFESSIONAL SCHOOL

Name of School:
Location:
Major/Minor/Course of Study:
Degree Received:
Name of School:
Location:
Major/Minor/Course of Study:
Degree Received:
Name of School:
Location:
Major/Minor/Course of Study:
Degree Received:

SPECIAL SKILLS, CERTIFICATIONS OR LICENSES RELATED TO JOB APPLYING FOR:

EMPLOYMENT HISTORY - List your most recent employment first:

Employer:
Telephone:
() - ext
Supervisor's Name and Title:
Address:
City:
State:
Zip:
Start Date:
End Date:
Position/Title:
Reason for leaving:
Description of duties performed:
If this is your current employer, do you authorize NAFCU to contact your current employer for a reference?
 
Employer:
Telephone:
() - ext
Supervisor's Name and Title:
Address:
City:
State:
Zip:
Start Date:
End Date:
Position/Title:
Reason for leaving:
Description of duties performed:
Employer:
Telephone:
() - ext
Supervisor's Name and Title:
Address:
City:
State:
Zip:
Start Date:
End Date:
Position/Title:
Reason for leaving:
Description of duties performed:
Employer:
Telephone:
() - ext
Supervisor's Name and Title:
Address:
City:
State:
Zip:
Start Date:
End Date:
Position/Title:
Reason for leaving:
Description of duties performed:
Employer:
Telephone:
() - ext
Supervisor's Name and Title:
Address:
City:
State:
Zip:
Start Date:
End Date:
Position/Title:
Reason for leaving:
Description of duties performed:

PROFESSIONAL REFERENCES - List at least three references (no family members):

*Reference's full name:
*Phone:
() - ext
*Address:
*City:
*State:
*Zip:
*Employment Relationship:
*How long has reference known you?
*NAFCU is hereby authorized to contact this professional reference  
*Reference's full name:
*Phone:
() - ext
*Address:
*City:
*State:
*Zip:
*Employment Relationship:
*How long has reference known you?
*NAFCU is hereby authorized to contact this professional reference  
*Reference's full name:
*Phone:
() - ext
*Address:
*City:
*State:
*Zip:
*Employment Relationship:
*How long has reference known you?
*NAFCU is hereby authorized to contact this professional reference  

GENERAL INFORMATION:

*Have you ever been involuntarily discharged or terminated from employment and/or been asked to resign to resign in lieu of being discharged?  

If yes, please explain:
*Have you ever been convicted, pled guilty to or pled no contest to any criminal offense by any court? (Having a criminal record does not necessarily disqualify you for employment. Each case is given individual consideration, based on job-related criteria.)  

If yes, please explain below:
* Remarks/Explanations:

PLEASE CAREFULLY READ THE FOLLOWING STATEMENTS:

Authority to Release Information: By my signature, I consent to the release of information to authorized employees of Northland Area Federal Credit Union which may include but not limited to information concerning my past and present work; including my official personnel files; attendance records, evaluations, education records including transcripts, military service, law enforcement records; and/or any personal record deemed necessary. In addition, I consent to authorize appropriate employees of Northland Area Federal Credit Union to make inquiries of third parties such as credit bureaus. I further release the organization, educational entity, present and former employers, law enforcement organization, and all third parties from any and all claims of whatever nature that I may have as a result of any inquiry or response given to such inquiries made in connection with my application for employment.

Certification of Applicant: By my signature, I affirm, agree, and understand that all statements on this form are true and accurate. Any misrepresentation, falsification, or material omission of information or data on this application may result in exclusion from further consideration or, if hired, termination of employment. If I have requested herein that my present employer not be contacted, an offer of employment may be conditioned upon acceptable information and verification from such employer prior to beginning work.

I agree that all claims arising from the interview/hiring process, my employment or the termination of my employment against Northland Area Federal Credit Union or against any of its directors, managers, officers, employees or agents, must be brought within 180 days of the occurrence giving rise to the claim or the day I should have known of the claim. I waive any longer, but not shorter, period of limitations. This 180 day limitations period also applies to the initial filing of a charge with the Equal Employment Opportunity Commission; however any civil action thereafter based on the allegations in the charge may be pursued according to the Notice of Right to Sue issued by the Commission.

I agree with the statements above. Intials:

 
 

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