Employment Application/background Check Disclosure And Authorization Form/etc. Page 2
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5EMPLOYMENT APPLICATION
EMPLOYMENT HISTORY
PRESENT/RECENT EMPLOYER
Employer:
Phone Number: (
)
Street Address:
City/Zip Code:
State:
County
Nature of Business
Position:
Employment Dates:
□
□
Part-Time:
Full-Time:
(mm/dd/yy)
From:
To:
Description of Duties:
Reason for Leaving
Employer:
Phone Number: (
)
Street Address:
City/Zip Code:
State:
County
Nature of Business
Position:
Employment Dates:
□
□
Part-Time:
Full-Time:
(mm/dd/yy)
From:
To:
Description of Duties:
Reason for Leaving
Employer:
Phone Number: (
)
Street Address:
City/Zip Code:
State:
County
Nature of Business
Position:
Employment Dates:
□
□
Part-Time:
Full-Time:
(mm/dd/yy)
From:
To:
Description of Duties:
Reason for Leaving
MILITARY SERVICE RECORD
Have you served in the U.S. Armed
Branch of Service:
Discharge Status:
Forces
□
□
Yes
No
PROFESSIONAL REFERENCES
MUST KNOW REFERENCE PROVIDED FOR AT LEAST ONE YEAR. DO NOT INCLUDE RELATIVES.
Name:
Address-City/State:
Day/Evening Phone:
I HEREBY CERTIFY THAT ALL THE INFORMATION I HAVE PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE. I
UNDERSTAND THAT ANY INCORRECT STATEMENT OR WILLFUL OMISSION OF FACTS MAY DISQUALIFY ME FROM
CONSIDERATION FOR EMPLOYMENT AND MAY CAUSE DISMISSAL IF HIRED. I AUTHORIZE BANDERA FIRST STATE BANK
TO OBTAIN ANY INFORMATION THAT PERTAINS TO THE CONSIDERATION OF MY EMPLOYMENT, I.E. ALL PERSONS,
SCHOOLS, COMPANIES, CORPORATIONS, AND LAW ENFORCEMENT AGENCIES.
EQUAL OPPORTUNITY EMPLOYER
Printed Name of the
Signature of Applicant
Date
Applicant
Employment Application
06/2014
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Parent category: Business