Application for Position: Part Time Service Representative - Greenville (Michigan)

INSTRUCTIONS: Please complete all portions of this employment application to be considered for employment. If you require accommodation during the employment process, including assistance in the completion of this employment application, please let us know. We are an equal opportunity employer. We do not discriminate on the basis of age, race, sex, religion, color, national origin, ancestry, marital status, disability, sexual orientation, arrest and court record or any other protected category recognized by state and federal laws. This employment application is valid for a three month period after submission to the credit union and only for the desired position. Consideration for employment after the three-month period requires completion and submission of a new application.

* indicates a required field.

*Social Security Number:

Social Security Number SSN Part 1 - Social Security Number SSN Part 2 - Social Security Number SSN Part 3

(for bondability and criminal conviction checks)

Date of Birth:

Driver's License:

Present Address:

Present Address Street

Present Address Apartment Number

Present Address City

Present Address State

Present Address Zip Code

Mailing Address(if different than above):

Mailing Address(if different than above) Street

Mailing Address(if different than above) Apartment Number

Mailing Address(if different than above) City

Mailing Address(if different than above) State

Mailing Address(if different than above) Zip Code

Work:

Work Area Code( ) Work Part 1 - Work Part 2 Work Extensionext:

Alternate Phone:

Alternate Phone Area Code( ) Alternate Phone Part 1 - Alternate Phone Part 2 Alternate Phone Extensionext:

*Have you ever used any other names?

Yes  No

(for background and criminal conviction checks)

If yes, please explain:

*Have you ever been convicted of a crime or entered a pretrial diversion program to avoid a conviction?

Yes  No

If yes, please list:

*Position applying for:

*Pay expected:

*Have you applied for work with us before?

Yes  No

Where?

When?

Where?

When?

*Apart from religious services, will you be able to work all other times?

Yes  No

(If hired, you will be required to perform work as required by the credit union.)

*In the last two years, have you have been reprimanded for errors, absenteeism and tardiness?

Yes  No

If yes, please explain:

*Who referred you to us?

M1 Website

Facebook

Lobby Signage

M1 Employee
Name:

Newspaper Ad
Name:

High School/College Placement Service
Name:

Employment Website
Name:

Other
Name:

*High School:

Major:

Years Spent:

Technical School:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

College:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

College:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

Graduate School:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

Other:

Major:

Years Spent:

Graduated?

Yes  No

Degree/Diploma:

Starting with your present or last job, provide complete employment history for the last 10 years. You must answer all questions and this employment history must be completed even if you submit a resume.

1. Name of Employer:

Phone Number:

Phone Number Area Code( ) Phone Number Part 1 - Phone Number Part 2 Phone Number Extensionext:

Employer Address:

Employer Address Street

Employer Address City

Employer Address State

Employer Address Zip Code

Ending Date of Employment:

Position Title and Duties:

Reason for leaving

May we contact this employer?

Yes  No

If no, explain:

2. Name of Employer:

Phone Number:

Phone Number Area Code( ) Phone Number Part 1 - Phone Number Part 2 Phone Number Extensionext:

Employer Address:

Employer Address Street

Employer Address City

Employer Address State

Employer Address Zip Code

Ending Date of Employment:

Position Title and Duties:

Reason for leaving

May we contact this employer?

Yes  No

If no, explain:

3. Name of Employer:

Phone Number:

Phone Number Area Code( ) Phone Number Part 1 - Phone Number Part 2 Phone Number Extensionext:

Employer Address:

Employer Address Street

Employer Address City

Employer Address State

Employer Address Zip Code

Ending Date of Employment:

Position Title and Duties:

Reason for leaving

May we contact this employer?

Yes  No

If no, explain:

Please provide the names of three persons you are not related to, you have known at least one year and whom we may contact.

*Phone:

Phone Area Code( ) Phone Part 1 - Phone Part 2 Phone Extensionext:

*Yrs. known:

*Phone:

Phone Area Code( ) Phone Part 1 - Phone Part 2 Phone Extensionext:

*Yrs. known:

*Phone:

Phone Area Code( ) Phone Part 1 - Phone Part 2 Phone Extensionext:

*Yrs. known:

*Summarize your job skills, training and/or study that are relevant for the desired position. Also, explain any periods that you were not working.

How many years of experience do you have with the following:

*Have you worked a job in the past two years that demanded working Saturdays? Yes  No

Authorization for Background Investigation and Acknowledgements

I authorize Michigan One Community Credit Union (Credit Union) and/or any entity directed by the Credit Union to obtain an investigative consumer report and/or consumer credit report for employment purposes, including verification of bondability. The reports may include any information as to my credit standing, character, educational achievements, general reputation, personal characteristics or mode of living, including information regarding job performance from previous employers.

I further understand and agree that an investigative consumer report and/or consumer credit report may be obtained at any time, and any number of times, as the Credit Union determines is necessary before, during or after my employment.

I understand that if I have misrepresented or omitted any facts on this application, and I am subsequently hired, I may be discharged upon discovery of the misrepresentations or omissions.

I acknowledge that an offer of employment is contingent upon the outcome of my background check, and in addition I may be required to undertake a post offer physical examination including a drug and alcohol test. Such examination would be conducted at a clinic selected by the Credit Union, and I hereby authorize any physician or clinic involved to release to the Credit Union information derived from the examination.