Are there any special skills you would like to include that you feel
might better qualify you for the job. (You may wish to include civic
and community activities, professional societies or special training
such as typing, accounting, etc.) Do not include information
which would reveal sex, race, color, age, national origin, religion,
veteran status or disability.
Please select the level of fluency with foreign languages,
Please check the following skills in which you are proficient:
(If you have any questions regarding this statement,
please ask a representative of the Human Resources Office before signing.)
I certify that answers given herein are true and complete.
I authorize Basile State Bank, (hereafter referred to as "the Bank")
to investigate all statements in this application and to secure any
necessary information from all my employers, references and academic
institutions. I also authorize the Bank to secure financial and credit
information through an appropriate agency. I understand that I have
the right to request that Basile State Bank, completely and accurately
disclose to me the source(s) of the credit information obtained. Such
a request must be made in writing to the Human Resources Office of the
Bank within a reasonable time after completion of this application.
Additionally, I authorize the Bank to supply my employment record, in
whole or in part, and in confidence, to any prospective employer, government
agency, or other party, with a legal and proper interest.
I further understand that any false information, misleading
statements or omission of facts will be sufficient cause for rejection
of my application if the Bank has not employed me and for immediate
dismissal if the Bank has employed me.
I also understand that the Bank has the right to modify
any of its policies without giving prior notice of the changes to me.
This application will be given every consideration, but its receipt
or communication with any Basile State Bank, official does not imply
that the applicant will be employed. I understand that if an employment
relationship is established, I have the right to terminate my employment
at any time for any reason. I also understand that the Bank retains
the right to terminate my employment at any time for any reason. No
supervisor or officer of the Bank has the authority to modify, in any
way, the "at will" employment relationship unless such modification
is reduced to a formal written agreement and signed by the President
of the Bank.
In the event of my employment with the Bank, I will
comply with all rules, regulations, and policies set forth in the Bank's
policy manuals or other communications distributed by the Bank. In addition,
I do hereby pledge myself to observe in confidence and not disclose
any information relating to Basile State Bank, business with any person,
firm or corporation, except such matters that I may have express authority
from an authorized officer of the Bank to disclose. I understand the
Bank promotes an alcohol/drug free workplace. I agree to abide by the
guidelines set forth in the Bank's alcohol/drug abuse policy.
I hereby acknowledge that I have read and understand
the preceding statements.