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Employment Application

We are an equal employment opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, sex, age, religion, national origin, known physical and mental impairments, pregnancy, childbirth, medical conditions related to pregnancy and childbirth, marital or civil union status, receipt of an order of protection, genetic information, military status, unfavorable discharge from military service, sexual orientation, gender related identity and use of leave provided by state and or federal law. Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process.


Personal Information

* Required Field
  Social Security Number - -
* Last Name
* First Name
  Middle Name
* Address 1
  Address 2
* City
* State
* Zip Code
  Email Address
* Phone Number() -
  Referred by
  Are you 18 years of age
  or older?



Employment Desired

  Position
* Date You Can Start / / (mm/dd/yyyy)
  Salary Desired
  If so, may we inquire of
  your present employer?


  Ever applied to this credit
  union before?


  If so, Where?
  If so, When?


Education

Grammar School

  Name and Location
  Graduated

  Sujbects Studied and
  Degree(s) Received

High School

  Name and Location
  Last Year Completed



  Graduated ?

  Subjects Studied
  and Degree(s) Received

College

  Name and Location
  Last Year Completed



  Graduated?

  Subjects Studied
  and Degress Received

Trade, Business or Correspondence School

  Name and Location
  Last Year Completed



  Graduated?

  Subjects Studied
  and Degrees Received


Former Employers

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

  Start Date / / (mm/dd/yyyy)
  End Date / / (mm/dd/yyyy)
  Salary (upon leaving)
  Reason for Leaving
  Name of Employer
  Address 1 of Employer
  Address 2 of Employer
  City of Employer
  State of Employer
  Zip of Employer
  Position


  Start Date / / (mm/dd/yyyy)
  End Date / / (mm/dd/yyyy)
  Salary (upon leaving)
  Reason for Leaving
  Name of Employer
  Address 1
  Address 2
  City of Employer
  State of Employer
  Zip of Employer
  Position


  Start Date / / (mm/dd/yyyy)
  End Date / / (mm/dd/yyyy)
  Salary (upon leaving)
  Reason for Leaving
  Name of Employer
  Address of Employer
  Address of Employer
  City of Employer
  State of Employer
  Zip of Employer
  Position


References

  Last Name
  First Name
  Middle Name
  Position
  Years Acquainted
  Address 1
  Address 2
  City
  State
  Zip
  Phone Number() -


  Last Name
  First Name
  Middle Name
  Position
  Year Acquainted
  Address 1
  Address 2
  City
  State
  Zip
  Phone Number() -


  Last Name
  First Name
  Middle Name
  Position
  Year Acquainted
  Address 1
  Address 2
  City
  Zip
  State
  Phone Number() -


Federal law prohibits a federal credit union or federally insured credit union from employing a person who has been convicted of a crime of dishonesty or breach of trust, or has entered into a pretrial diversion program, absent prior approval from the federal regulator. Please identify whether you have been convicted of any of the following crimes during the last ten years:

  receiving or claiming gifts
  for procuring loans;


  theft, embezzlement or
  misappropriation of money,
  funds or securities;


  falsifying bookkeeping
  entries for loans, in
  exchange for
  compensation;


  submitting, false, forged or
  counterfeit statements or
  documents to NCUA;


  falsifying statements on
  loan/credit applications to
  overvalue land or property
  to federal agencies;


  knowingly concealing
  assets from NCUA
  liquidating agent;


  fraud;

  obstructing exam of
  financial institution by
  federal agency;


  money laundering;

  monetary transactions in
  property derived from
  specific unlawful activity;
  and/or


  participation in pretrial
  diversion program.



PLEASE READ CAREFULLY BEFORE SIGNING

I understand that by completing this application, Rock Valley Credit Union does not guarantee a job interview or an offer of employment. If employed, I understand that my employment is for no definite period of time and can be terminated at any time and for any reason by either Rock Valley Credit Union or me.

I have read and agree to the above and hereby certify that the facts I provided in my employment application are true and complete. If I misrepresent or deliberately leave out a fact in my application, I may be disqualified from further consideration or if employed, I may be dismissed immediately.

  Applicant's Signature
  Date Signed


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Routing #: 271988388|NMLS # 597779
Equal Housing LenderNational Credit Union Administration
NCUA - Your savings federally insured to at least $250,000 and backed by the full faith and credit of the United States Government. National Credit Union Administration, a U.S. Government agency. Equal Housing Lender - We do business in accordance with the Fair Housing Law and Equal Opportunity Credit Act