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Employment Application

Personal Information

Last Name
First Name
Middle Initial

Address 1
Address 2
City
State
Zip Code
E-mail Address
Phone Number
Referred By
Are you 18 years old or older?	Yes No

Employment Desired

Position
Date You Can Start
Salary Desired
Are You Employed Now?	Yes No
If So, May We Inquire of Your Present Employer?	Yes No
Ever Applied to This Credit Union Before?	Yes No
If So, Where?
If So, When?

Education

Grammar School
Name and Location
Graduated	Yes No

High School
Name and Location
Last Year Completed	1 2 3 4
Graduated	Yes No
Subjects Studied and Degree(s) Received

College
Name and Location
Last Year Completed	1 2 3 4
Graduated	Yes No
Subjects Studied and Degree(s) Received

Trade, Business or Correspondence School
Name and Location of School
Last Year Completed	1 2 3 4
Graduated	Yes No
Subjects Studied and Degree(s) Received

General
Subjects of Special Study or Research Work
Job Related Skills

Health

How Many Days Have You Been Absent From Work In The Past 12 Months?

Name and Address of Person to Be Notified In Case of Emergency

Former Employers

List below your last three employers, starting with the most current.

Employer #1
Employer Name
Date From
Date To
Salary Upon Leaving
Reason For Leaving
Employer Address 1
Employer Address 2
Employer City
Employer State
Employer Zip
Position

Employer #2
Employer Name
Date From
Date To
Salary Upon Leaving
Reason For Leaving
Employer Address 1
Employer Address 2
Employer City
Employer State
Employer Zip
Position

Employer #3
Employer Name
Date From
Date To
Salary Upon Leaving
Reason For Leaving
Employer Address 1
Employer Address 2
Employer City
Employer State
Employer Zip
Position

Military

Have You Had Any Experience In the United States Armed Forces? Yes No
If Yes, What Branch? Discharge Date
Rank at Discharge

Are You Now In The Reserves? Yes No. If Yes, Date Obligation Ends
List Any Special Training You Have Received.

References

Last Name
First Name
Middle Initial
Years Acquainted
Address 1
Address 2
City
State
Zip
Phone Number

Last Name
First Name
Middle Initial
Years Acquainted
Address 1
Address 2
City
State
Zip
Phone Number

Last Name
First Name
Middle Initial
Years Acquainted
Address 1
Address 2
City
State
Zip
Phone Number

Applicants Authorization and Understanding

I represent to PARDA Federal Credit Union that all of the information provided by me now or in the future in support on my application for employment is true and complete. If hired, I agree that false information, misrepresentation or material omission provided by me in this application or in support of my application may result in discipline or discharge.

I authorize PARDA Federal Credit Union to release and verify any of the information provided by me concerning my employment, education, driving, or medical history with the appropriate individuals, companies, institutions or agencies. I further authorize them to release such information, as PARDA requires, including prior disciplinary record, without any obligation to give me written notice of such disclosure.

I hereby waive any claims I might have on account of any such inquiries and disclosures, and by submitting this application, I release PARDA, its officers, employees, agents, affiliates,successors and assigns from any and all liability whatsoever that might arise on account of such inquiries and disclosures.

I agree that this application will be considered only for a period of six months after its date. After this six month period, this application will be null and void. Any continuing interest in employment with PARDA must be evidenced by later applications for employment.

If hired, I agree my employment and compensation can be terminated, with or without cause and with or without notice, at any time at the will of either PARDA or myself. In consideration of my employment, I waive any right to commence any suit or action against PARDA because of the termination of my employment. I understand that no employee, manager, executive, or other representative of PARDA, other than the president of PARDA has the authority to enter into any agreement for employment for any specified period of time, or to make any oral or written agreement contrary to the foregoing. I further understand that only an agreement in writing signed by me and the by the president of PARDA can modify the foregoing. I also agree to conform to the rules and regulations of PARDA.

I also agree and understand that, by executing this agreement, I am accepting employment as an at-will employee, and my acceptance of employment as an at-will employee supersedes, revokes, cancels and negates any and all prior statements, agreements, practices, policies, and representations, oral or written, that PARDA would employ me on other than an at-will basis or for other than an indefinite term.

I further agree not to commence any action or suit relating to my employment with PARDA more than six months after the date of termination of such employment and to waive any statute of limitations to the contrary.

I further agree that my employment is conditional upon satisfactory completion of documentation as required by the Immigration Reform and Control Act of 1986. I agree that the Credit Union is authorized to make inquiries pertaining to my employment, credit standing, and financial responsibility.

I Authorize and Understand The Above Information.

I Do Not AuthorizeThe Above Information.

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