It is the policy of WEPCO FCU to comply with various federal and state laws prohibiting discrimination because of age, sex, race, color, religion, national origin, disability, marital, and veteran status. Please exclude any information that indicates the sex, age, race, color, religion, national origin, or disability of the applicant

Please answer all questions neatly and completely — this form is part of your personnel record.

The items marked with (*) are required fields.


Personal Information
Social Security Number --
*Last Name
*First Name
Middle Name
Other Name Employed Under
 
Address 1
Address 2
City
County
State
ZIP code -
How Long?
 
Home Telephone Number --
 
Are you over 18 and under 70 years of age?Yes No
 
Are you legally eligible to work in the U.S.? Yes No
Authorization #
 
Are you related to anyone employed by the Credit Union? Yes No
Relationship
Name
 
Were you previously employed by the Credit Union? Yes No
Date Started
Date Left
Department
Reason for leaving
 
Have you ever been convicted of a felony? Yes No
If yes, explain
 
Have you ever had an application for bond canceled or declined? Yes No
By whom?
Reason
 
Type of work desired
Date Available
Wage or salary desired
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Education
High School
Name and Location
Start Date (Month/Year)   End Date (Month/Year)  
Last Year Completed 9 10 11 12
Graduated? Yes No
Degree or Course
 
Community College
Name and Location
Start Date (Month/Year)   End Date (Month/Year)  
Graduated? Yes No
Degree or Course
 
College
Name and Location
Start Date (Month/Year)   End Date (Month/Year)  
Last Year Completed 13 14 15 16
Graduated? Yes No
Degree or Course
 
Graduate School
Name and Location
Start Date (Month/Year)   End Date (Month/Year)  
Graduated? Yes No
Degree or Course
 
If you did not graduate, why did you leave school or college?
 
List any scholastic honors earned in high school or college.
 
Are you currently pursuing further studies? Yes No
Day School   Night School
Where are you attending?
 
What courses are you presently taking or planning on taking?
 
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Employment History

List below the last four employers, starting with the most recent one first.

Start Date //
End Date //
Starting Salary
Final Salary
Supervisor's Name
Reason for Leaving
Name of Employer
Type of Business
May we contact? Yes No
Address 1 of Employer
Address 2 of Employer
City of Employer
State of Employer
Zip of Employer -
Phone
Last Position
Describe work and responsibilities
 
Start Date //
End Date //
Starting Salary
Final Salary
Supervisor's Name
Reason for Leaving
Name of Employer
Type of Business
May we contact? Yes No
Address 1 of Employer
Address 2 of Employer
City of Employer
State of Employer
Zip of Employer -
Phone
Last Position
Describe work and responsibilities
 
Start Date //
End Date //
Starting Salary
Final Salary
Supervisor's Name
Reason for Leaving
Name of Employer
Type of Business
May we contact? Yes No
Address 1 of Employer
Address 2 of Employer
City of Employer
State of Employer
Zip of Employer -
Phone
Last Position
Describe work and responsibilities
 
Start Date //
End Date //
Starting Salary
Final Salary
Supervisor's Name
Reason for Leaving
Name of Employer
Type of Business
May we contact? Yes No
Address 1 of Employer
Address 2 of Employer
City of Employer
State of Employer
Zip of Employer -
Phone
Last Position
Describe work and responsibilities

Military Service
Start Date (Month/Year)   End Date (Month/Year)  
Branch of Service
Highest Rank Attained
Are you a member of a Military Reserve or National Guard unit? Yes No
What specific training did you have while in the military that is related to the position for which you have applied?
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Time Lapses
Start Date (Month/Year)   End Date (Month/Year)  
Explain  
 
Start Date (Month/Year)   End Date (Month/Year)  
Explain  
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Please write a short statement indicating the skills, training, computer software, or activities which qualify you for the stated position. State any training seminars previously attended.
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ACKNOWLEDGMENTS

In processing this employment application, the Credit Union may request that an investigative consumer report be prepared, which may include information as to your character, work experience, police and credit record. You have the right to request that the company disclose to you the nature and scope of the investigation. Such a request must be made in writing to the Human Resources Department within 90 days after you complete this application.

I hereby acknowledge that I have read the foregoing disclosure and understand the same.


Name

Date

PLEASE BE ADVISED THAT UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT.


Name

Date

In the event of my employment by the Credit Union, I will comply with all rules and regulations as set forth in the Credit Union's policy manual or other communications distributed to all employees. I understand that if I am hired, my employment with the Credit Union will be AT WILL and may be terminated by the Credit Union or me at any time for any reason. I understand that no documents or statements of the Credit Union will constitute a contract of employment that in any way limits the Credit Union's right to terminate my employment AT WILL. I further understand that the AT WILL nature of my employment cannot be changed except by a formal written contract signed by the President of the Credit Union.

I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers, and that the responses given are true, complete and accurate to the best of my knowledge and are made in good faith. Without limiting the AT WILL status of my employment if I am hired, I understand that if any of the statements on this application are untrue I may be immediately discharged.

I also authorize the companies, schools or persons named in this application to give any information regarding my employment, character, ability or experience together with any information they may have regarding me. I hereby release said companies, schools or persons from all liability for damage from issuing this information. I also release the Credit Union from liability resulting from obtaining this information.

I agree to submit to a pre-employment physical and/or drug screen, if required by the Credit Union.

I hereby acknowledge that I have read the above statements and understand the same.


Name

Date