Job Application

This EEO Policy Statement is a reminder that all employees are protected from discrimination under the laws we enforce. Employees and applicants for employment are covered by federal laws and Presidential Executive Orders designed to safeguard employees and job applicants from discrimination on the basis of race, color, religion, sex (including pregnancy) national origin, age, disability, veteran status or any other classifications protected by federal, state or local law. These protections extend to all management practices and decisions, including recruitment and hiring, appraisal systems, promotions, training, and career development programs. Consistent with these obligations, the bank also provides reasonable accommodations to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for sincerely held religious beliefs, observances, and practices.

Former Employers

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

I certify that the facts contained in this application and any accompanying resume are true and complete to the best of my knowledge. I understand that any falsification, omission, misrepresentation or concealment of information on this application or resume may be sufficient grounds for disqualification from further consideration for hire or immediate discharge and that the company shall not be liable in any respect if my employment is so denied or terminated.

I authorize investigation and verification of all statements contained herein and the references and former employers and employees to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise to include credit history, education, employment verification, personal references and criminal records. I release the company from all liability for any damage that may result from receiving and/or using such information.

I hereby understand and acknowledge that, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and the Employer may discharge Employee at any time with or without cause or notice a long as it does not violate local, state or federal law. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I also understand that this application and any employee manuals or handbooks that may be distributed to me shall not be construed or relied upon as a contract.

Our company provides goods and services to government entities through a variety of business relationships. To fulfill the obligations of these types of contracts require, we need to collect, maintain and occasionally report information related to employees.

At this time, we are asking you to help us meet our obligations by completing the forms and information listed on the following pages. Please note that the information will only be used in accordance with the provisions of applicable laws, executive orders, and regulations. Providing this information is voluntary and refusal to so will not result in any adverse treatment. The information you provide will be held in strict confidence except that:

1. Necessary management and supervisory personnel may be informed to ensure proper placement and to provide reasonable job accommodations;
2. First aid and safety personnel may be informed to the extent appropriate, if the condition might require emergency treatment; and
3. Government officials investigating affirmative action program compliance may have access to reported information.

Thank you for your cooperation in this important initiative.

Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. if you want to learn more about this law or this form, visit the US Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability.

Disabilities include, but are not limited to:
• Alcohol or other substance use disorder (not currently using drugs illegally)
• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
• Blind or low vision
• Cancer (past or present)
• Cardiovascular or heart disease
• Celiac disease
• Cerebral palsy
• Deaf or serious difficulty hearing
• Diabetes
• Disfigurement, for example disfigurement caused by burns, wounds, accidents or congenital disorders
• Epilepsy or other seizure disorder
• Gastrointestinal disorders, for example, Chron’s Disease, irritable bowel syndrome
• Intellectual or developmental disability
• Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSDy
• Missing limbs or partially missing limbs
• Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
• Nervous system condition, for example, migraine headaches, Parkinson’s disease or Multiple sclerosis (MS)
• Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
• Partial or complete paralysis (any cause)
• Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
• Short stature (dwarfism)
• Traumatic brain injury

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection on information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.