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SEFCU Insuance Agency Employment Application

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* indicates a required field

Date of Application:*
Position Applied For:*

 
Referral Source:*  
                                                    
  If "Newspaper" - Please provide name of newspaper
 
  If "Internet" - Please provide name or address of website
 
  If "Employment Agency" - Please provide name of employment agency
 
  If "SEFCU Employee" - Please provide name of employee
 
  May we contact this employee?
       
  If "Other" - Please provide details. 

 
   
Last Name:*
First Name:*
Middle Initial:
Address 1:*
Address 2:
City:*
State:*  
Zip Code:*
E-mail:*
Phone:*
Have you ever been refused bonding?*
                                                  
  
If employed and you are under age 18, can you furnish a work permit?*  
                   
Are you related to a current SEFCU employee?*
                                                 
                If yes, please provide employee name and relationship:
                  
                  
Have you ever filed an application here before?* 
                                                 

                If yes, please provide date of application:

Have you ever been employed here before?*
                                                 

                If yes, please provide date of employment: From:  To:

Are you employed now?*
                                                 
   
May we contact your employer?*
                                                 
   
Are you prevented from lawfully becoming employed in this country because of a Visa or Immigration Status? (Proof of citizenship or immigration status is required upon employment).*
                                                 
Date available for work:*   
Are you available to work:*
                                                
Are you on lay-off and subject to recall?*
                                                
Can you travel if the job requires it?*
                                                

 
Education
 
 
High School:*   

Address of the school:*

 

Number of years completed:*

 

Diploma/Degree:*

Describe course of study:

 

 

College/University:  

Address of the school:

 

Number of years completed:

  

Diploma/Degree:

 

Describe course of study:

 

 

 

Graduate/Professional:    

Address of the school:

 

Number of years completed:

 

Diploma/Degree:

 

Describe course of study

 



Describe specialized training, apprenticeship, internship, extra-curricular activities and special skills:
 

Honors received:
 
 
Veteran of the U.S. Military service?*
                                            
If yes, enter branch name:   
List professional, trade, business or civic activities and offices held. (You may exclude those which indicate race, color, religion, sex, or national origin):
 
 

 


 
Employment Experience

Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin.
Employer 1:*   
Telephone:*   
Address:*    
Job Title:*   
Supervisor:*   
Reason for Leaving:*    
Dates Employed:* From:  To:
Hourly Rate/Salary:* Starting:   Final:   
Work Performed:*
   

 
Employer 2:  
Telephone:  
Address:  
Job Title:  
Supervisor:  
Reason for Leaving:  
Dates Employed: From:  To: 
Hourly Rate/Salary: Starting:  Final: 
Work Performed:
 

 
Employer 3:
Telephone:
Address:
Job Title:
Supervisor:
Reason for Leaving:
Dates Employed: From:  To: 
Hourly Rate/Salary: Starting:  Final: 
Work Performed:
 

 
Employer 4:
Telephone:
Address:
Job Title:
Supervisor:
Reason for Leaving:
Dates Employed: From:  To: 
Hourly Rate/Salary: Starting:  Final: 
Work Performed:
 
 


 
Please provide three business references:
Business
reference 1:
 
Name:*
Relationship:*
Contact Number:*
Contact's E-mail Address:*

 
Business
reference 2:
 
Name:*
Relationship:*
Contact Number:*
Contact's E-mail Address:*

 
Business
reference 3:
 
Name:*
Relationship:*
Contact Number:*
Contact's E-mail Address:*

 
Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience.*
 
 

 

State any additional information you feel may be helpful to us when considering your application.
 
 

 


 

Applicant's Statement
I certify that the answers given are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment.

In the event of employment I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the company. 

 

 

Equal Employment Opportunity/Affirmative Action Employer - Minority/Females/Veterans/Disability