Step 1 of 3 33% Application for EmploymentName* First Middle Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone Number*Email Address Position Applied For*Select a positionFull-Time Float CSA I – Branch Administration – Multiple LocationsMortgage Consultant – Retail Lending – Portsmouth BranchReferral Source*AdvertisementIndeed.comLinkedIn.comFriendRelativeEmployment AgencyWalk InIf you are under 18 years of age, can you provided required proof of your eligibility to work?YesNoHave you ever filed an application with us before?YesNoIf so, please provide date: Have you ever been employed with us before?YesNoIf so, please provide date: Are you currently employed?YesNoAre you currently a member of our U.S. Military?YesNoDo you have present membership in the National Guard or Reserves?YesNoAre you eligible to be lawfully employed in this country? (Proof of citizenship or immigration status will be required upon employment.)YesNoOn what date would you be available for work? Can you travel if a job requires it?YesNoAdditional Information Do you have the full physical, mental, emotional, and medical ability to do the job for which you have applied? If not, please explain.If you need a reasonable accommodation to do the job for which you have applied, please explain.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. References Please provide name, address and telephone number of three references who are not related to you and are not previous employers. NameAddressPhoneNameAddressPhoneNameAddressPhoneDocumentationUpload Resume:*Optional: Upload Cover Letter:Optional: Upload Non-compete Agreement:Representation Regarding Other Obligations: This application of employment is conditioned on your representation that you are not subject to any confidentiality, non-competition agreement or any other similar type of restriction that may affect your ability to devote your full attention to your work at the Bank. If you have entered into any agreement that may restrict your activities on behalf of the Bank, please include a copy of this agreement with your application. Applicant’s Statement I certify that answers given herein 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 and hereby acknowledge that any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause and with or without notice. It is further understood that this “at will” employment relationship may not be altered by any written document or by conduct unless such alteration is specifically acknowledged in writing by the president of this bank. 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 employer. This application for employment does not constitute a contract of employment between applicant and the Sanford Institution for Savings. Applicant Data Record Applicants and Employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical conditions or handicap/disability, or any other legally protected status. We comply with government regulations, including affirmative action responsibilities where they apply. Solely to help us comply with governmental record keeping, reporting and other legal requirements, we request that you please fill out the Applicant Data Record. We appreciate your cooperation. This data, and the data for Part 3 of this application upcoming, is for periodic government reporting and will be kept in a confidential file separate from the Application for Employment. Your cooperation is voluntary.GenderMaleFemaleSelect one of the following Race/Ethnic GroupsSelectHispanic or LatinoWhiteAsianNative American Indian/Alaskan NativeBlack or African AmericanTwo or more RacesNative Hawaiian or Other Pacific IslanderOtherIf Native American Indian, check if any of the following are applicableFormal member of a particular tribeHave a membership card issued by the tribeHave a Certificate of Degree of Indian Blood issued by the Bureau of Indian AffairsAre considered an American Indian in your communityUsed American Indian School or hospitalAre you a Veteran?YesNoDefinitions A Disabled Veteran means (i) 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 Veterans Affairs, or (ii) a person who was discharged or released from active duty because of a service-connected disability. 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 the Executive Order 12985 (61 Fed. Reg. 1209) at http://www.opm.gov/veterans/html/vgmedal2.asp. Recently Separated Veterans 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. Active Duty Wartime or Campaign Medal (Other Protected) Veterans 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. For those with Internet access, the information required to make this determination is available at http://www.opm.gov/veterans/html/vgmedal2.htm. Information also may be obtained by sending an email to firstname.lastname@example.org or by calling (301) 306-6752. Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2020 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 disabilities.* 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 feat of any 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: Blindness Autism Bipolar Disorder Post-Traumatic Stress Disorder (PTSD) Deafness Cerebral Palsy Major Depression Obsessive Compulsive Disorder Cancer HIV/AIDS Multiple Sclerosis (MS) Impairments requiring the use of a wheelchair Diabetes Schizophrenia Missing limbs or partially missing limbs Intellectual disability (previously called mental retardation) Epilepsy Muscular Dystrophy Do I have a disability?Yes, I have a disability (or previously had a disability)No, I don't have a disabilityI don't wish to answerNameDate 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. *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 Contact Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.