Employment Application - Haverhill Bank

GENERAL INFORMATION AND POSITION DESIRED

First Name

Middle Name

Last Name

Street Address

City

State

Zip Code

Phone Number

Position Applied For

Salary Requirements

Dates Available to Work

How were you referred to us?

Are you legally permitted to work in the United States?

Yes No

Are you able to provide documentation demonstrating your legal ability to work in the Unites States?

Yes No

Have you been employed by the Bank previously?

Yes No

Have you applied for a position at the Bank before?

Yes No

Do you currently have a relative employed by the Bank?

Yes No

Use the space below to describe your interest in banking and the skills and aptitudes that you feel qualify you for a position at the Bank.

EDUCATION

In each field including school name; city, state; major (if applicable) and years completed or degree.

Please indicate your highest level of education:

High/Prep School Business School College Graduate Work

High/Prep School

Business School

College

Graduate Work

List scholastic honors, offices held and activities in high school and college:

If you did not graduate, why did you leave school or college:

Are you planning to pursue further studies:

Yes No

If yes, where and what courses?

EMPLOYMENT RECORD

Please list the most recent information first. Account for all periods of time and all positions held over the last ten years, including military service. You may include volunteer positions if you wish.

Current or Most Recent Employment – Include Employer, position, dates employed, reference name & number, reason for leaving

Past Employment – Include Employer, position, dates employed, reference name & number, reason for leaving

Have you ever been involuntarily terminated from employment in any job, including but not limited to any of the positions identified in this application or your resume?

Yes No

If yes, please explain any and all such circumstances:

If presently employed, why do you desire to change your position?

If you are now employed, may we contact your present employer?

Yes No

DISCLOSURES

The Bank is an equal employment opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religious creed, national origin, sex, gender identity, sexual orientation, genetic information, ancestry, age, disability, military or veteran status or any other category protected by federal or state law. No question on this application is intended to secure information to be used for such discrimination.

It is unlawful in Massachusetts to require or administer a lie detector test as condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

This application will be given consideration, but its receipt does not imply that you will be employed. The Bank at its own expense, arranges for a bond for each of its employees. If your (the applicant’s) background is unacceptable to a bonding company (under standards that do not discriminate on an illegal basis), it will be difficult to secure this bond, and the Bank may not offer employment to you.

AFFIDAVIT

PLEASE READ CAREFULLY BEFORE SIGNING. If you have any questions regarding this statement, please ask them of an employment interviewer before signing.

I authorize the Bank to make inquiries regarding my work and educational history from any of my past employers and from educational institutions that I have attended. I release the Bank, as well as my past employers and educational institutions, from any and all liability or damage for requesting and/or issuing this information.

I acknowledge receipt of a separate stamen that the Bank may obtain a consumer report on me for purposes of this employment application and, should I become employed by the Bank, at any time during my employment with the Bank.

I understand that if I am hired, I must provide proof of eligibility to work in the United States. If I do not provide such proof within three (3) days of my hire, I understand that the Bank may terminate my employment.

I understand that, if I am hired, my employment with the Bank will be at will and may be terminated by the Bank or me at any time and for any reason. I understand that no documents or statements of the Bank will constitute a contract of employment that in any way limits the Bank’s right to terminate employment at will. I further understand that the at-will nature of my employment cannot be changed except by a formal written contract signed by both the President of the Bank and me.

Without limiting in any way the at-will status of my employment if I am hired, I understand that if any of the information I have provided on this application or any accompanying resume is untrue, the Bank will immediately discharge me.

I hereby acknowledge that I have read the above statement and understand the same.

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