Employment Application | Fairfield Federal Savings & Loan, Lancaster, Ohio

Fairfield Federal — Application for Employment 111 East Main Street • P.O. Box 728 • Lancaster, Ohio 43130-0728 • 740-653-3863

We are pleased that you are interested in applying for employment with Fairfield Federal. This Association does not discriminate in hiring or regarding any term, condition, or privilege of employment on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age of any person whose age is 40 or over, protected veteran status, disability, genetic information, familial status (having one or more children under the age of 18), or marital status. No question on this form is intended to request information to be used for any such discrimination.

We will give this application every consideration. However, in accepting it, Fairfield Federal makes no commitment of employment to the applicant.

All officers and employees of the Association are subject to being dismissed at will, including, but not limited without good cause by the Board of Directors of its Executive Committee.

We will consider this application to be active for six months from the date you submit it. After six months you must submit a new application if you wish to continue to be considered for employment.

Basic information

Last name

First name

Middle name

Street address

City

State and ZIP

Telephone

Email address

Are you at least 18 years of age?

Are you legally eligible to work in the United States?

Verification will be required upon hire.

Position applied for

Location

Salary requirements

Date available

How were you referred to us?

If you have any disability which could limit you in the performance of the job for which you are applying, please describe how, with or without reasonable accommodation by the Association, you will be able to perform job-related functions.

Please contact our Personnel Director at 740-653-3863 if you require a reasonable accommodation to apply for a job or to perform your job.

Work history

Start with your present or most recent job. List self-employment, summer and part time jobs.

May we contact the above employers for reference checking purposes?

Please identify by number any employer you do not wish us to contact.

Machine operation

Check the machines which you can operate.

Typewriter
Computer
Calculator
Keyboard

Other

Computer software programs with which you are familiar

Education

Education history: name and address of school, major course or subject, last year completed and degree
Level of education	Name	Address	Major course / subject	Last year completed	Degree

Other (describe)

Are you planning to pursue further studies?

Yes
No
Day school
Night school

If so, when, where, and what courses?

Interests

Describe your interest in the financial industry and the skills and aptitudes that you feel qualify you for a position at the Association. You may wish to include civic and community activities, professional societies in which you participate, hobbies, sports, special training or skills such as typing, accounting and the like.

If you need more space, please continue on a separate sheet.

References

Please list the names, addresses, and phone number of two personal references. Please exclude relatives and former employers.

Reference 1 — name

Address

Phone

Reference 2 — name

Address

Phone

Are you related to any employee of Fairfield Federal?

Convictions

Have you ever been convicted of any crime involving dishonesty, or a breach of trust, or money laundering? If so, please explain. (12 U.S.C. 1829)

Authorization to obtain further information

I authorize Fairfield Federal to make whatever inquiries it may deem reasonably necessary, to contact persons who are not consumer reporting agencies, to contact past and present employers, and to obtain consumer reports from consumer reporting agencies in connection with my application for employment.

I authorize any person, employer, or consumer reporting agency to respond to inquiries from Fairfield Federal, to compile information, and to furnish said Fairfield Federal with any information obtained as a result of such inquiries in connection with my application for employment.

I further authorize Fairfield Federal, in its sole discretion, to furnish copies of this authorization and my application to any person(s) or consumer reporting agency(ies) in connection with my application for employment.

Disclosure statement. Under Section 615 of the Fair Credit Reporting Act, whenever employment is denied either wholly or partly because of information contained in a consumer report from a consumer reporting agency, the user of the consumer report shall so advise the applicant against whom such adverse action has been taken and supply the name and address of the consumer reporting agency making the report.

I hereby acknowledge that I have read and understand the foregoing Authorization and Disclosure. I hereby certify that all of the statements I have made in this application are true and complete to the best of my knowledge and belief.

Signature

Sign by hand after printing.

Date

Request for transcript

Complete this section only if you would like us to request a transcript of your grades.

Name of school or university

City and state

My name while I was a student at that school or university was

I hereby request and authorize the school named above to furnish a transcript of my grades to Fairfield Federal Savings and Loan. Please mail a copy of the requested transcript to: Fairfield Federal Savings and Loan, ATTN: Personnel Director, 111 E Main St, PO Box 728, Lancaster, OH 43130-0728.

Signature

Sign by hand after printing.

Date

Pre-offer invitation to self-identify as a protected veteran (voluntary)

Fairfield Federal is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. Our Affirmative Action Plan is designed to set forth and measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. The classifications of protected veterans are defined as follows:

A “disabled veteran” is (1) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veteran Affairs, or (2) a person who was discharged or released from active duty because of a service-connected disability.
A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.
An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An “Armed Forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 FR 1209).

If you believe you belong to any of the categories of protected veterans listed above, please indicate below. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended.

I identify as one or more of the classifications of protected veteran listed above.
I am NOT a protected veteran.

Name

Date

Applicant self-identification (voluntary)

Fairfield Federal is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Fairfield Federal Savings & Loan Association invites you to voluntarily self-identify your sex, ethnicity, and race. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Last name

First name

Middle name

Number and street

City

County

State

ZIP code

Sex

Female
Male

Ethnicity — are you Hispanic or Latino?

Race — what race or races do you consider yourself to be? Check only one.

White (Not Hispanic or Latino)
Black or African American (Not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
Asian (Not Hispanic or Latino)
American Indian or Alaskan Native (Not Hispanic or Latino)
Two or More Races

If you do not wish to furnish this information, please initial here

Date

Your answers stay on your own device. Print the completed application, sign it, and mail or bring it to 111 East Main Street, Lancaster, Ohio 43130.