Application For Employment We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. (PLEASE PRINT) Position(s) Applied For Date of Application How Did You Learn About Us? Advertisement Friend Walk-In PB Employee Employment Agency Relative Other Last Name First Name Middle Name Number Street City State Zip Code Social Security Number If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No Have you ever filed an application with us before? Yes No If Yes, give date Have you ever been employed with us before? Yes No If Yes, give date Are you currently employed? Yes No May we contact your present employer? Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment. Yes No On what date would you be available for work? Are you available to work: Full time Part Time Shift Work Temporary Are you currently on "lay-off" status and subject to recall? Yes No Can you travel if a job requires it? Yes No Do we currently employ a member of your family or household? Yes No Have you been convicted of, or are you awaiting trial for a crime (other than minor traffic violations)? Conviction will not necessarily disqualify an applicant from employment. Yes No If Yes, please explain WE ARE AN EQUAL OPPORTUNITY / REASONABLE ACCOMMODATION EMPLOYER
Education Name and of School Course of Study Years Completed Diploma Degree Elementary School High School Undergraduate College Graduate Professional Other (Specify) Indicate any foreign languages you can speak, read and / or write FLUENT GOOD FAIR SPEAK READ WRITE Describe any specialized training, apprenticeship, skills and extra-curricular activities. Describe any job-related training received in the United States military.
Employment Experience Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may leave blank any organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Employer Dates Employed Employer Dates Employed Employer Dates Employed Employer Dates Employed If you need additional space, please continue on a separate sheet of paper. List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:
Additional Information Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience. Specialized Skills Check Skills/Equipment Operated Calculator Dictaphone Fax Shorthand Type Words Per Minute Knowledge Of Computer Software Programs (list): State any additional information you feel may be helpful to us in considering your application. Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Are you able to perform the essential functions of the jobs for which you are applying? If your answer is no, please specify any reasonable accommodations that would allow you to perform the essential functions of the job? Yes No References 1.() (Name) Phone # () 2.() (Name) Phone # () 3.() (Name) Phone # ()
FAIR CREDIT REPORTING ACT CONSUMER REPORT/INVESTIGATIVE CONSUMER REPORT DISCLOSURE AND RELEASE OF INFORMATION AUTHORIZATION PLEASE REVIEW CAREFULLY BEFORE SIGNING AUTHORIZATION I authorize Pinnacle Bank, and Risk Assessment Group, Inc., a consumer-reporting agency, to retrieve information from all personnel, educational institutions, government agencies, companies, corporations, credit reporting agencies, law enforcement agencies at the federal, state or county level relating to my past activities, and authorize the foregoing entities to supply any and all information concerning my background. The information received may include, but is not limited to academic, residential, achievement, job performance, attendance, litigation, personal history, credit reports, driving records, and criminal history records. I understand that an Investigative Consumer Report ( Consumer Report ) may be prepared summarizing this information. If my prior employers and/or references are contacted, the report may include information obtained through personal interviews regarding my character, general reputation, personal characteristics and/or mode of living. I may request a copy of any Investigative Consumer Report that is prepared regarding me and may also request the nature and substance of all information about me contained in the files of the consumer-reporting agency. The consumer-reporting agency is required to provide someone to explain the contents of my file. I understand that proper identification will be required and that I should direct my request to: Risk Assessment Group, LLC. P.O. Box 27443, Tempe, Arizona 85285. Phone 866-777-1114. I am willing that an electronic or photocopy of this authorization be acceptable with the same authority as the original; and that if employed by the above named company (except if employed in the state of California), this authorization will remain in effect throughout such employment. By my signature below, I acknowledge receipt of this Disclosure and Release of Information Authorization and certify that I have read and understand it. Signature Social Security Number Date Personal Telephone Contact Number Email NOTE: The following information is needed to conduct a background investigation and IS NOT considered as part of your application. It is used only for identification purposes in verifying information on your Employment Application. PLEASE PRINT CLEARLY. Last Name First Name Middle Name Please list all aka s including maiden names Street City State Zip Code Driver s License Number State of License Expiration Date Date of Birth www.riskassessmentgroup.com 866-777-1114
RELEASE OF INFORMATION AUTHORIZATION Pre-employment Background Screening Pinnacle Bank The following information is helpful to your potential employer when processing your pre-employment background check. Providing the following information will expedite your approval for employment. You are not required to release this information. If you are currently employed may we contact your employer? Yes No Post Hire Only I understand that an Investigative Consumer Report may be prepared summarizing the information contained in my background check. I understand that I have the right to inspect any Investigative Consumer Report with reasonable notice during regular business hours and that I may be accompanied by one other person. I should direct my request to: Risk Assessment Group, LLC. P.O. Box 27443, Tempe, Arizona 85285. Phone 866-777-1114. I hereby certify that all the statements and answers set forth on the application form and/or my resume are true and complete to the best of my knowledge, and I understand that if subsequent to employment any such statements and/or answers are found false or that information has been omitted, such false statements or omissions will be just cause for the termination of my employment. Further, I understand that by requesting this information, no promise of employment has been made. California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law. Minnesota applicants or employees only: By signing below you also acknowledge that you understand that you have the right to make a request in writing to the consumer reporting agency of the nature and scope of the report, if any, and the agency is obligated to respond to your request within five days of your request for further information or of your request for the report, whichever is later. Please check this box if you would like to receive a copy of a consumer report at no charge if one is obtained by the Company. Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report at no charge if one is obtained by the Company. First Name Middle Name Last Name Last School Graduated from Campus Location (City, state) Degree Earned (Degree,Diploma,GED) Year of Graduation Name while attending school, if different from above: Signature Date www.riskassessmentgroup.com 1-866-777-1114 Risk Assessment Group, Inc. Privacy Policy: http://www.riskassessmentgroup.com/privacy.aspx