If you have a disability and require a reasonable accommodation to participate in the pre-employment process, please advise the company's representative of your requested accommodation.

(Application must be completed in full)

How were you referred to Kirkpatrick Bank?

Walk In      Advertisement       State Employment Agency       Placement Agency







Have you ever worked for Kirkpatrick Bank?     Yes      No

If so, and .

Reason for leaving.




Do you currently have relatives employed by Kirkpatrick Bank?       Yes       No

If so, .



What position(s) are you applying?




Are you able to work full-time or part-time?     Full-Time      Part-Time

If part-time, what hours or days are you available?

         

 

EDUCATION

Please list any education, training, or specialized experience you feel relates to the position(s) applied for that would help you perform the work, such as high school, colleges, degrees, licenses, vocational or technical programs, military training, foreign language proficiency, etc.


High School

 

Did you graduate?     Yes      No



College/University

 

   


Other

 

   



Please list any other degrees, certifications, licenses, special training, foreign language skills, or experience that will aide in performing the job.




 

BACKGROUND INFORMATION

In order to be considered an applicant with our organization you must be at least (1) 18 years old; (2) legally eligible for employment in the United States; and (3) bondable.


Are you 18 years of age or older?     Yes      No

Are you bondable?      Yes      No

Have you ever been denied bond?      Yes      No

Have you ever pled guilty or "no contest" to a felony charge or been convicted of a felony?      Yes      No

If yes, state where, when and the nature of the offense.
(Information regarding criminal history will not necessarily bar applicant from employment and such information will be revieiwed in light of duties relating to job sought.)



Are your legally eligible to work in the United States?      Yes      No

Will you now, or in the future, require sponsorship for employment (i.e., H1-B Visa, etc.)?      Yes      No

EMPLOYMENT HISTORY
(Include U.S. Military Experience) (List Most Recent First)

 

 

Reason for Leaving




 



Describe your work and responsibilities

 

 

 

Reason for Leaving




 



Describe your work and responsibilities

 

 

 

Reason for Leaving




 



Describe your work and responsibilities

 

 

 

Reason for Leaving




 



Describe your work and responsibilities



 

REFERENCES

ACKNOWLEDGEMENT AGREEMENT

Please carefully read the following before submitting your online application, since it contains terms and conditions that affect your application and potential employment, or, if you have already been hired, your continued employment.

In exchange for Kirkpatrick Bank's consideration of this application and my possible employment and/or my continued employment with Kirkpatrick Bank, I agree to the following terms and conditions:

1. Authorization and Release: I hearby certify that all questions answered on the application are true and correct. I authorize Kirkpatrick Bank to conduct an investigation of my qualifications for employment, including verification of my educational history. I realize that the investigation may include contacting prior employers, references, and educational institutions I have attended, unless I have indicated otherwise on this form. I release any and all persons and parties connected with the investigation from any and all claims or damages arising from the furnishing of information as part of that investigation. I authorize the use of any information in this application to verify my statements, and, except as indicated above I authorize the past employers, all references , and any other person to answer all questions asked concerning my ability, character, reputations, and previous education or employment record.

2. Employment-at-Will: I understand that any employment I might obtain with Kirkpatrick Bank is at-will. I further acknowledge that company policies, manuals, or other similar documents are meant to be explanations of benefits or programs and they do not change the terms of my at-will employment. I also understand that only the Department Head of the Human Resources department has the authority to change my at-will status, and then only if in writing and specific to the individual; and that at any time or for any reason, I may resign my position or Kirkpatrick Bank may terminate my employment.

3. Criminal-Record Check and Credit Worthiness Check: Unless restricted by law, I understand that in conjunction with my application for employment, Kirkpatrick Bank will conduct a criminal-record check of criminal convictions and pending prosecutions in accordance with applicable federal and state laws along with a credit check and that information obtained as a result of this record check may, but will not necessarily, result in my not receiving an offer of employment, withdrawal of my offer of employment, or termination of employment.

4. Confidential Information: During and after any employment with Kirkpatrick Bank, I will not divulge or appropriate for my own use or for the use of others, except as Kirkpatrick Bank may authorize or direct, any knowledge or information obtained by me during my employment and considered by Kirkpatrick Bank to be secret or confidential. At the end of my employment, I will return all property of Kirkpatrick Bank.

5. Authorization to Work in the United States: I understand that if I am offered employment with Kirkpatrick Bank, I must provide documentation to establish that I am either a U.S. citizen or a foreign national lawfully authorized to work in the United States and that if I am unable to provide such documentation, my offer of employment may be revoked.

I verify that the information I have provided on this application (or related to my application) is true, complete, and accurate and that I am legitimately seeking a job with Kirkpatrick Bank.

I understand that any omission of information requested or any false or misleading information that I furnish on or in connection with the application for employment, including my authorization for a criminal-record check, may result in rejection of my application and/or may be considered justification for termination of employment if discovered at a later date.

By submitting this application form, I certify that I have read and agree to the terms of the above employment understanding.

Invitation for Self-Identification

In order to help us comply with government record keeping, reporting and other legal requirements, we request that you complete this affirmative action survey. The completion of this form is voluntary. This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.

Government Agencies require periodic reports on the gender, ethnicity, disability, and veteran status of applications. This data is for analysis and affirmative action only. This information is voluntary and will be treated confidentially. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment.

Male Female

Check one of the following:

White. An individual, not of Hispanic origin, with origins in any of the original peoples of Europe, North Africa, or the Middle East.

African American (Black). An individual, not of Hispanic origin, with origins in any of the Black racial groups of Africa.

Hispanic or Latino. A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. This does not include persons of Portuguese descent or persons from Central or South America who are not of Spanish origin or culture.
Check one: (Black) (Latino) (White)

Native Hawaiian. A person with origins in the original Hawaiian tribes.

Other Pacific Islander. A person with origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This includes, for example, China, Japan, Korea, the Philippines, and Samoa; and on the Indian Subcontinent, includes India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim and Bhutan.

American Indian/Alaskan Native. A person with origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition.

Other: