NuVista Federal Credit Union 2711 Commercial Way, Montrose, Co 81401 Phone: (970)497 5378 Fax: (970)497 5379 Email: slobato@nuvista.org Employment Application Our Company is an Equal Opportunity Employer. All applicants will be considered regardless of race, color religion, sex, national origin, age, marital, veteran status, disability, or any other legally protected status. Equal access to the hiring process, services, and employment is available to all persons. Applicants requiring accommodations to the application and or interview process should contact a representative of the HR Department. Answer each question completely and accurately. No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the United States will be required if an offer of employment is made. Applicant Information: Name Last First Middle Address Street Apt# City State ZiP Code Home Phone ( ) Cell Phone ( ) Email Driver License Number State Expiration Date Position Applied Have you applied with NuVista Federal Credit Union in the past? Yes date: No. If yes please give Have you ever been employed by NuVista Federal Credit Union? Yes date: No. If yes, please give Can you provide proof that you are of legal work status in the United States? Yes No Do you have relative(s) currently working for NuVista Federal Credit Union? Yes No 1
If yes, please provide their name(s). Hours available : Full Time Part Time Temporary What date would you be available for work? Wage expected? Please list any languages you are fluent in if job related: Are you over the age of 18? Yes No Have you ever been convicted of or plead guilty to or no contest to a felony or misdemeanor other than minor traffic violations such as speeding? Yes No If yes, please explain: Education: High School College/University Diploma/Degree Year Graduated Course of Study Employment Experience: 1) Employer : Telephone: 2
2) Employer : Telephone: 3) Employer : Telephone: Skills/Training: Please list your specialized skills or training: Please list professional, trade, business, or civic associations and any offices held. Exclude memberships that would reveal gender, race, religion, national origin, age, color, disability or other protected status. 3
Please list job related special accomplishments, publications and awards: References: Please give the name and telephone number of three (3) business/work references who are not related to you. Please list at least one of your previous supervisors. Name Company Job Title Phone Name Company Job Title Phone Acknowledgements Accuracy of Information: I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration of employment, re employment, and may result in termination if employed. Information Release: I authorize NuVista Federal Credit Union to contact any company, institution, or individual it deems appropriate t investigate my employment history, character, qualifications, driving record, and other job related information. I give my full consent for all contacted persons, including former employers, to provide the information concerning this application. Further, I waive my right to bring a claim against these individuals for any damages arising from furnishing the requested information to NuVista Federal Credit Union. I also release NuVista Federal Credit Union from all liability that might result from checking such references. Drug Testing: A post offer drug and/or physical examination may be required. I understand that as allowed by the Americans with Disabilities Act, any offer of employment may be withdrawn if I test 4
positive for drugs and/or if a condition is discovered which does not permit me to perform the essential functions of the job and for which no reasonable accommodation can be made. Application Status: I understand that this application is current for only 60 days. At the conclusion of this time, if I have not heard from NuVista Federal Credit Union and still wish to be considered for employment, It will be necessary to complete a new employment application. At Will Employment: I understand that if I am hired, my employment at NuVista Federal Credit Union is AT WILL and may be terminated by me or by Nuvista Federal Credit Union at any time for any reason, with or without cause or notice. I understand that no employment offer is being made by NuVista Federal Credit Union at this time. I also understand that this application is not a contract of employment. Applicant Statement: I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or its agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that as an applicant offer a position with this company, I may be asked to demonstrate that I am capable of performing tasks with are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a post offer drug test. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of the employer. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Applicant Signature Date Revised 04/16/2013 5