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First South Bank Employment Application

Please Read Before Filling Out This Application

We are pleased that you are interested in applying for a position with our financial institution. This institution does not discriminate in hiring or employment on the basis of race, color, religious creed, national origin, sex or ancestry; or on the basis of age against persons 40 and over; or on the basis of disability against qualified individuals with disabilities as defined by the Americans with Disabilities Act. No question on this form is intended to secure information to be used for such discrimination.

We will give this application every consideration. However, in accepting it, First South Bank makes no commitment of employment to the applicant.

Personal Data

Please answer every question.
* *
Address * * * *
Home PhoneCell Phone *Email Address *
Do you have a relative employed at, or on the Board of Directors of, First South Bank? * Yes No
Name Relationship

* Required

POSITION

Position applying for * Salary Requirement $ *
How were you referred to us? Date available to work *
Are you willing to (if applicable to the position you are applying for):
Work full time? *YesNo
Work part time? *YesNo If Yes, indicate days and hours
Work on a temporary basis? *YesNo If Yes, indicate days and hours
Work on an on-call basis? *YesNo If Yes, indicate days and hours

* Required

EDUCATION

Name and Location Address Major Course/Subject Last Year Completed Did You Graduate Degree
YesNo
YesNo
YesNo
YesNo
YesNo
List scholastic honors, offices held and activities in high school and college:
Are you planning to pursue further studies? * YesNo
If yes, please describe:

* Required

SKILLS

Can you operate a personal computer? * Yes No
If yes, indicate software experience:
Please list any other skills, licenses or certifications that would contribute to your employment with First South Bank:

* Required

CONVICTIONS

Have you ever been convicted of a crime, including conviction for writing bad check(s), crimes involving dishonesty, breach of trust or theft but not including minor traffic violations? (A yes response does not necessarily preclude you from the selection process.) * Yes No

If Yes, provide information: *

* Required

PREVIOUS EMPLOYMENT

 

1. Company Name * Address * Telephone *
Dates Employed *
Position *
Job Duties *		 Starting Salary $ *
Leaving Salary $ * 		Supervisor *
Reason for Leaving * May We Contact? *
Yes No
2. Company Name Address Telephone
Dates Employed
Position
Job Duties 		Starting Salary $
Leaving Salary $ 		Supervisor
Reason for Leaving May We Contact?
YesNo
3. Company Name Address Telephone
Dates Employed
Position
Job Duties 		Starting Salary $
Leaving Salary $		 Supervisor
Reason for Leaving May We Contact?
YesNo
4. Company Name Address Telephone
Dates Employed
Position
Job Duties 		Starting Salary $
Leaving Salary $		 Supervisor
Reason for Leaving May We Contact?
YesNo

* Required

REFERENCES

Please list the names, addresses and phone numbers of two personal references, excluding relatives. *

* Required

SPECIAL INTERESTS

Use the space below to describe your interest in the financial industry and the skills and aptitudes that you feel qualify you for a position at this institution. (You may wish to include civic and community activities, professional societies in which you participate, special training or skills such as typing, accounting, etc.)

CERTIFICATION AND ASSENT

In the event of any employment by First South Bank, I will comply with all rules and regulations as set forth in the bank policy manual and other communications available to all employees. I further understand that if employed, my employment can be terminated, with or without notice, if I fail to comply with First South Bank’s policies and procedures; if the credit check, criminal check, does not meet bank standards; or if for any other reason the bank or I wish to terminate the employment relationship.

I authorize the bank to supply my employment record in part or whole, and in confidence to any prospective employer, government agency, or other party, with a legal and proper interest.

I hereby authorize any or all of my former employers to furnish First South Bank with any information concerning my employment history which they have on record or otherwise and hereby release these former employers and all individuals associated with them from all liability for any damage incurred in furnishing such information.

If accepted for employment, I understand that I will be on a period of probation for the first 180 days of my employment.

To the best of my knowledge the information contained on this application is complete and accurate. I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between me and First South Bank for either employment or the provision of any benefits; and further understand that if an employment relationship is established, I will have the right to terminate my employment at any time and First South Bank will have the same right.

I have read and I accept this Certification and Assent. *

* Required

Affirmative Action Program (Using EEO Race Categories)

NOTE: THIS INFORMATION WILL BE KEPT PRIVATE

It is First South Bank’s policy not to unlawfully discriminate against any employee or applicant for employment on the basis of race, color, religion, national origin, sex, sexual preference or orientation, marital status, age, physical or mental disability, or status as a special disabled veteran, veteran of the Vietnam era, or other eligible veteran.

First South Bank is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, First South Bank invites employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws executive orders, and regulations including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Sex Information *

I do not wish to supply this information
Male Female

Race Information *

I do not wish to supply this information
Hispanic or Latino
White (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
Asian (not Hispanic or Latino)
American Indian or Alaska Native (not Hispanic or Latino)
Two or More Races (not Hispanic or Latino)

Status as an Individual With a Disability, Special Disabled Veteran, Veteran of the Vietnam Era, and Other Eligible Veteran.

If you are an individual with a disability, a Vietnam era veteran, or a special disabled veteran and would like to be considered under our affirmative action program, please indicate how you would like to be identified by checking the appropriate box.

Individual With a Disability Vietnam Era Veteran Special Disabled Veteran Other Eligible Veteran (has served in a campaign/expedition since Vietnam)

If you are an individual with a disability or a special disabled veteran, please indicate what, if any, reasonable accommodations you believe you need to perform the job you are applying for properly and safely.

* Required