Applicant Info
How did you learn about us?
Advertisement
Friend / Relative
Walk-in
Employment Agency
Farmers State Bank Website
Other
Farmers State Bank Employee
Employee Name
This field is required
Are you applying to work:
Full-Time
Part-Time
Temporary / Seasonal
Weekends
Name
This field is required
Address
This field is required
City
This field is required
State
This field is required
Zip
This field is required
Telephone Number
This field is required
Mobile / Other Phone Number
This field is required
Email Address
This field is required
Have you ever filed an application with us before?
Yes
No
If yes, please give date(s)
This field is required
Have you ever been employed with us before?
Yes
No
If yes, please give date(s)
This field is required
Are you currently employed?
Yes
No
If so, where?
This field is required
May we contact your present employer?
Yes
No
If yes, please provide name and contact information:
This field is required
Yes
No
On what date would you be available for work?
This field is required
Are you currently on lay-off status and subject to recall?
Yes
No
Have you ever been convicted of a felony?
Yes
No
If yes, please provide date of conviction and a description of what conviction was for
This field is required
Education
High School
Name and Location of School
This field is required
Years Completed
This field is required
Diploma / Degree
This field is required
Undergraduate College
Name and Location of School
This field is required
Course of Study
This field is required
Years Completed
This field is required
Diploma / Degree
This field is required
Graduate / Professional
Name and Location of School
This field is required
Course of Study
This field is required
Years Completed
This field is required
Diploma / Degree
This field is required
Other (Specify)
Name and Location of School / Training
This field is required
Course of Study
This field is required
Years Completed
This field is required
Diploma / Degree
This field is required
Professional Organizations
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.
Describe any specialized training, apprenticeships, skills, extra-curricular activities, job-related training received in the United States military or qualifications acquired from employment or other experience.
Specialized Skills
Word
WordPerfect
Lotus 1-2-3
Excel
Access
PowerPoint
Calculator
Keyboarding
Fax Machine
Do you hold any state certificates or licenses?
Yes
No
If yes, please list
This field is required
State any other additional information which you feel may be helpful to use in considering your application
This field is required
Employment Experience
Start with your present or most recent job. Include any job-related military service assignment and volunteer activities. You may exclude employment which would reveal gender, race religion, national origin, age, ancestry, disability, or other protected status.
Most Recent Position
Employer
This field is required
Address
This field is required
City
This field is required
State
This field is required
Zip
This field is required
Phone
This field is required
Job Title
This field is required
Supervisor
This field is required
From
This field is required
To
This field is required
Full-Time
Part-Time
Work Performed
This field is required
Reason for Leaving
This field is required
May we contact this employer for references?
Yes
No
Previous Position
Employer
This field is required
Address
This field is required
City
This field is required
State
This field is required
Zip
This field is required
Phone
This field is required
Job Title
This field is required
Supervisor
This field is required
From
This field is required
To
This field is required
Full-Time
Part-Time
Work Performed
This field is required
Reason for Leaving
This field is required
May we contact this employer for references?
Yes
No
Previous Position
Employer
This field is required
Address
This field is required
City
This field is required
State
This field is required
Zip
This field is required
Phone
This field is required
Job Title
This field is required
Supervisor
This field is required
From
This field is required
To
This field is required
Full-Time
Part-Time
Work Performed
This field is required
Reason for Leaving
This field is required
May we contact this employer for references?
Yes
No
References
Reference 1
Name
This field is required
Phone
This field is required
Address
This field is required
City
This field is required
State
This field is required
Zip
This field is required
Reference 2
Name
This field is required
Phone
This field is required
Address
This field is required
City
This field is required
State
This field is required
Zip
This field is required
Reference 3
Name
This field is required
Phone
This field is required
Address
This field is required
City
This field is required
State
This field is required
Zip
This field is required
Voluntary Survey
Government agencies at times require periodic reports on the sex, ethnicity, disability, veteran and other protected status of employees. This data is for statistical analysis with respect to the success of the Affirmative Action program.
SUBMISSION OF THE FOLLOWING INFORMATION IS VOLUNTARY
Date
This field is required
Name
This field is required
Address
This field is required
Current Job
This field is required
Male
Female
Ethnicity (check one of the following)
White
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Asian
American Indian / Alaskan Native
Black or African American
Two or More Races
Other
Check if any of the following are applicable
Vietnam Era Veteran
Disabled Veteran
Disabled Individual
Veteran
Birthdate
This field is required