An Equal Opportunity Employer
We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, veteran status, or any other category protected by law.
Answer each question completely and accurately. No action will be taken on this application until you have answered all relevant questions. The following questions are not intended to imply illegal preferences or discrimination based upon non-employment related information.
A 'yes' answer does not automatically disqualify you from employment, since the nature of the offence, date, and the job for which you are applying is also considered.
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Please provide months and years.
List names and addresses of schools.
Exclude labor organizations and memberships which reveal race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, veteran status or any other category protected by law.
Provide 3 references, not relatives or former employers.
Please read each statement carefully before signing
I understand that this application or subsequent employment does not create a contract of employment or a guarantee of employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice.
By signing below, I acknowledge that I have read this document in its entirety and consent to the statements above.
This application for employment will remain active for a limited time.
Employment Inquiry Release
In connection with your application for/continued employment with the Jonestown Bank & Trust Company, on their behalf, CBY Systems Inc. will make inquiries, including but not limited to, your consumer credit history, education, professional licensing, criminal history, driving history, your performance, experience and other qualities pertinent to your qualifications for employment, including reasons for termination of past employments. Such inquiries may include investigative consumer reports that relate to your character, general reputation, personal characteristics, or mode of living and are obtained by personal interviews with your neighbors, friends, associates, and others.
In compliance with the Fair Credit Reporting Act (FCRA), you are entitled to be informed if an offer of employment is withheld because of information obtained from CBY Systems Inc. and, in that event, upon your written request, CBY Systems Inc. will provide a copy of the consumer and/or investigative consumer reports we receive, information regarding the nature and scope of the investigation, and the FTC notice, "A Summary of Your Rights Under the Fair Credit Reporting Act." A copy of "A Summary of Your Rights Under the Fair Credit Reporting Act" is also linked from this Employment Inquiry Release.
Please complete and sign this form authorizing, without reservation, any party, including, but not limited to, employers, consumer reporting agencies, law enforcement agencies, state agencies, institutions and private information bureaus or repositories, contacted by CBY Systems Inc. to furnish any or all of the above mentioned information, including consumer reports and/or investigative consumer reports. Your signature allows a photocopy or fax copy of this authorization to be as valid as the original.
* Date of birth is requested only for the purposed of identification in obtaining accurate retrieval of records and it will not be used for discriminatory purposes.
Voluntary Self Identify Form
Jonestown Bank & Trust Co. is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program.
Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as disabled, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.
Please check all that apply (see below for definitions)
*Editor's note: According to 41 CFR 60-741-42, there are only two circumstances when an employer may ask a disabled applicant to self-identify on a pre-offer basis.
- The invitation is made when the contractor actually is undertaking affirmative action for individuals with disabilities at the pre-offer stage; or
- The invitation is made pursuant to a Federal, state or local law requiring affirmative action for individuals with disabilities.
**Editor's note: According to 41 CFR 60-250-41, there are only two circumstances under which an employer may ask applicants who are Special Disabled Veterans to self-identify on a pre-offer basis:
- The invitation is made when the contractor actually is undertaking affirmative action for special disabled veterans at the pre-offer stage; or
- The invitation is made pursuant to a Federal, state or local law requiring affirmative action for special disabled veterans.
Voluntary Self-Identification of Disability
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities1. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of punishment because you did not identify as having a disability earlier.
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
- Cerebral palsy
- Muscular dystrophy
- Bipolar disorder
- Major depression
- Multiple sclerosis (MS)
- Missing limbs or partially missing limbs
- Post-traumatic stress disorder (PTSD)
- Obsessive compulsive disorder
- Impairments requiring the use of a wheelchair
- Intellectual disability (previously called mental retardation)
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
1 Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
Equal Opportunity Employment Notice