Education

High School or equivalent institution
Name:
Location:
Diploma or GED?YesNo
Advanced Education - College, University, or Vocational/Technical (Applicants may be asked to furnish transcripts of school or college work where appropriate.)

Name of Institution	Location / Address	Major	Diploma or Degree Received

Skills

Office Skills (if applicable): Testing may be required.

Typing WPM:
PBX/Switchboard

Personal Computer (PC)

Mainframe Computer

10-Key Calculator

Copier
Other Please specify:

List all computer software and hardware with which you are familiar:

Scholastic Awards, Honors, etc.:

Many of our members do not speak English or prefer to conduct business in a language other than English. Do you speak a language other than English?Yes No
If yes, which language(s)?

Work History

Give employment history as completely as possible, starting with your present or most recent employer. For any unemployed periods, show activities, dates and location. Include U.S. Military Service. NOTE: Our employment process includes VERIFICATION of employment history. Please indicate any employers we should not contact.

Current or Most Recent Position
Employer:
Position Held:
Business Address:
City/State/ZIP:
Business Phone:	( ) May we contact?YesNo
Supervisor's Name:
Supervisor's Title:
Supervisor's Phone:	( )
Salary (Base Pay):	Hourly   Weekly  Monthly   Annually
Beginning Salary:
Ending Salary:
Dates Employed (Month / Year)
From:
To:
Reason for Leaving:
Your Responsibilities:
First Previous Position
Employer:
Position Held:
Business Address:
City/State/ZIP:
Business Phone:	( ) May we contact?YesNo
Supervisor's Name:
Supervisor's Title:
Supervisor's Phone:	( )
Salary (Base Pay):	Hourly   Weekly  Monthly   Annually
Beginning Salary:
Ending Salary:
Dates Employed (Month / Year)
From:
To:
Reason for Leaving:
Your Responsibilities:
Second Previous Position
Employer:
Position Held:
Business Address:
City/State/ZIP:
Business Phone:	( ) May we contact?YesNo
Supervisor's Name:
Supervisor's Title:
Supervisor's Phone:	( )
Salary (Base Pay):	Hourly   Weekly  Monthly   Annually
Beginning Salary:
Ending Salary:
Dates Employed (Month / Year)
From:
To:
Reason for Leaving:
Your Responsibilities:

General Information

Have you ever been convicted of a criminal offense involving dishonesty or breach of trust?Yes No

If yes, give offense, date and disposition of case:*

*You are not required to disclose any arrest or detention that did not result in conviction; any conviction for which the record has been judicially expunged, sealed or statutorily eradicated; any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed; or any arrest for which a pretrial diversion program has been successfully completed. A conviction will not necessarily disqualify you from employment.

Have you ever had a fidelity bond modified, cancelled or refused?YesNo

If yes, please explain:

Certification


The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice. You are also hereby authorized to take my fingerprints and submit my fingerprints to local, state or federal law enforcement agencies for the purpose of obtaining information as to the existence and nature of any criminal record concerning me, if any, relating to convictions or for any arrest for which I am now released on bail or on my own recognizance pending trial, for the commission or attempted commission of a crime involving robbery, burglary, theft, embezzlement, fraud, forgery, bookmaking, receiving stolen property, counterfeiting, or involving checks or credit cards or using computers. I agree to notify the Credit Union immediately if I should be convicted of any crime involving dishonesty or breach of trust while my application is pending or after I am hired. If my employment with the Credit Union is terminated for dishonesty or loss of confidence, authorities will be notified and I may be prosecuted. I further understand, that if I should be hired, the Credit Union has the authority to transfer me to any position or branch depending on the needs of the Credit Union.

Should I become employed by the Credit Union I agree to abide by the Bylaws of the Credit Union including, but not limited to confidentiality of member's records. I further agree not to transport off Credit Union premises any document pertaining to a member, ex-member or other employees without the expressed written permission of my immediate supervisor. I agree to hold the Credit Union harmless, indemnify and defend them from all liability from loss, damage, or injury arising out of or incident to this agreement, including without limitation, all consequential damages, whether or not resulting from my acts or those of my agent.

I hereby agree that this employment application does not constitute an offer of employment. I further agree and understand that if I am hired by North Island Credit Union, my employment will be on an "at will" basis, and can be terminated by either me or North Island Credit Union at any time for any reason with or without cause. I also agree and understand that the "at will" nature of my employment relationship (assuming I am hired) cannot be changed except in writing signed by the President of North Island Credit Union.

Authorization and Release of Liability for Personal Background Information Investigation
As an applicant for employment with NORTH ISLAND CREDIT UNION, I hereby authorize North Island Credit Union to make any background investigation of my personal history and financial and credit report history as it deems necessary. I understand and agree that a consumer credit report may be obtained as part of my employment application.

I understand and consent to you obtaining a consumer report on me as part of my employment application, and that this consent, if I am hired, is a blanket, prospective consent to any workplace investigation into alleged misconduct attributed to me, and to the obtaining and use of consumer reports for purposes of enforcing North Island Credit Union's policies during my term of employment. I also consent to North Island Credit Union's post-employment procurement and use of consumer reports in any post-employment dispute with me.

I understand this background investigation may include, but is not limited to: work history, personal financial status and credit history; criminal conviction record, including pending trials, as permitted by law; driving history including traffic violations; and references obtained from professional and personal associates.

I also agree that I will allow North Island Credit Union to fingerprint me, and that North Island Credit Union may deliver fingerprints taken of me to any local, state or federal law enforcement agency for the purpose of obtaining information as to the nature and extent of a criminal record concerning me, if any, relating to convictions and for any arrest for which I am now released on bail or on my own recognizance pending trial, for the commission or attempted commission of a crime involving robbery, burglary, theft, embezzlement, fraud, forgery, bookmaking, receiving stolen property, counterfeiting, or involving checks, credit, debit or ATM cards using computers.

I hereby fully release North Island Credit Union, its employees, directors, agents, successors and assigns, and all other parties involved in this background investigation, including but not limited to investigators, credit agencies and those companies or individuals who provide information to North Island Credit Union concerning me, from any claims or actions for any liability whatsoever related to the process or results of a comprehensive investigation of my background.

I acknowledge and agree that this release applies to all claims for injuries, damages, or losses, whether known or unknown, foreseen or unforeseen, and I hereby waive application of California Civil Code Section 1542, which provides as follows:

 
A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him, must have materially affected his settlement with the debtor.

I understand and acknowledge that the significance and consequence of this waiver of California Civil Code Section 1542 is that even if I should eventually suffer damages as a result of the activities described in this Authorization and Release, I will not be able to make any claim for those damages.

I further agree to provide records and information that may be requested of me by North Island Credit Union in connection with this background investigation, including but not limited to: employment records in my possession to support previous work history; substantiation of prior and current compensation; and such other records as may be necessary.

I also certify that all representations made by me, and all information provided to North Island Credit Union are true to the best of my knowledge. I understand that misrepresentation of fact and providing false information will exclude me from further consideration as an applicant, and may result in termination of my employment with North Island Credit Union if I am hired by North Island Credit Union before the discovery of the misrepresentation or falsity of the documents or information.

I understand that this Authorization and Release is not an offer of employment by North Island Credit Union or a contract for employment with North Island Credit Union. I further understand North Island Credit Union operates under an AT-WILL-EMPLOYMENT POLICY and this Authorization and Release does not alter or affect that policy in any manner whatsoever.

Applicant Survey


CONFIDENTIAL-FOR STATISTICAL PURPOSES ONLY

Notice to Applicant: Completion of this Form is Voluntary
Applicant Flow Data for Research and Reporting only

North Island Credit Union, and its subsidiaries, is an Affirmative Action, Equal Opportunity employer. The Federal government requires us to compile statistical information about applicants for employment. In an effort to enable us to meet these requirements and better evaluate the effects of our selection process, applicants are requested (but not required) to complete this section. Any information you volunteer will be kept confidential. This form will be removed from your application prior to consideration for employment and will be used solely for research and statistical purposes.

1. FemaleMale

2. 40 Years of age or over.

How were you referred for employment?

Advertisement in Publication:
Employee Referral
Sign in Branch
Walk-In
Mail-In
Jobline
Employment Agency
Internet
Former Employee
Job Fair Location:
School:
Other:

3. Please check only one in this section:

 

4.		VETERAN OF THE VIETNAM ERA (Active duty of 180 days or more, any part of which occurred between August 5, 1964 and May 7, 1975, with a release or discharge other than dishonorable). U.S. Military Service From: to
5.		DISABLED VETERAN (Any person entitled to disability compensation under laws administered by the Veterans Administration or a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty).
6.		DISABLED VIETNAM-ERA VETERAN (Any disabled person who had served in the Military for a continuous period of 180 days or more, any part of which occurred between August 5, 1964 and May 7, 1975).
7.		VETERAN (Any person not covered above).
8.		DISABLED (any person who had a physical or mental disability which substantially limits one or more of such person's major life activities, has a record of such a disability or is regarded as having such a disability).

This information will be kept confidential except that (1) Supervisors and Managers may be informed regarding work restrictions or accommodations; (2)First Aid and safety personnel may be advised to the extent appropriate; and (3) Government Officials investigating compliance with the Rehabilitation Act or the Vietnam Era Veterans Readjustment Assistance Act may have access to the information.