Employment Application

General Information

LaPorte CFCU does not discriminate in employment practices on account of race, creed, color, national origin, ancestry, sex, age, marital status, veteran status, disability, sexual orientation, arrest record, conviction record, membership in the national guard, use or non use of lawful products on our premises, genetic information, or any other reason prohibited by state or federal law.

Please contact LaPorte CFCU directly if you need an accommodation to participate in the application process.

Note: This application must be filled out in its entirety even if we permit you to submit a resume and you are doing so.

Note: This application is effective for 30-days from application date. After 30-days it expires and you must renew your application to be considered for another job opening.

• Last Name*
• First Name*
• Is any additional information about a name change, use of an assumed name,or nickname necessary to enable a check on your work record?*
  Yes No
• If so please explain:
• Present Address*
• Present City*
• Present State*
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Present Zip*
• Have you lived at this present address for less than two years?*
  Yes No
• Last Previous Address
• Last Previous City
• Last Previous State
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Last Previous Zip
• Phone*
• Email*
• Are you over 18 years of age?*
  Yes No
• Are you presently legally authorized to work in the United States?*
  Yes No
• Have you ever been convicted of a crime? (Answering yes to this question is not an automatic bar to employment)*
  Yes No

Employment Information

• Position Desired*
• Salary Desired (Hourly or Annually)*
• Salary in Most Current Position*
• Status*
  Full-Time Part-Time
• Earliest Start Date*
• Do you have any commitments to another employer that might affect your employment with this organization?*
  Yes No
• If so please explain:
• How were you referred to this organization?*
  Newspaper Ad Friend/Employee On my own Employment Agency School State Employment Service Other
• Where did you hear about this job opening?*
• Have you worked or applied to the Credit Union in the past?*
  Yes No
• Please specify the date you applied or began work.

Work Experience

Account for all employment since high school, or the last ten years, whichever is less, with most recent work experience first.

Education Background

• High School*
• Address*
• Course of Study*
• Degree*
• College/Tech*
• Address*
• Course of Study*
• Major*
• Minor*
• Degree*
• Graduate School*
• Address*
• Course of Study*
• Degree*
• List additional job-related seminars, short courses, workshops, or other educational experiences, along with the approximate date of completion:*
• List job-related certificates and licenses along with dates obtained: *
• List any other job-related skills and abilities:*

Disclosures

Please check the appropriate boxes before submitting this application. If you have any questions about any of the following statements, please ask about them before submitting.

• I certify that all information and statements I have provided in this application and in any accompanying documents are accurate and complete.*
• I understand that providing false or misleading information on this application form or on any materials I provide with it could result in my not being hired or in termination of my employment if I am hired.*
• I understand that my past and present employers and educational institutions may be contacted to verify my references.*
• I authorize the LaPorte CFCU to conduct a background check on me and to contact and verify my references. (If the Credit Union plans to obtain a credit report, it will first obtain my authorization and signature on a separate document)*
• I understand and acknowledge that in the event I am hired, my employment will be at-will meaning LaPorte CFCU can terminate it at any time for any reason that is not unlawful. The at-will relationship will remain throughout my employment unless I enter into a written agreement stating otherwise from the board of directors or an officer of the Credit Union with authority to enter into the agreement. *
• I acknowledge that no offer or promise of employment has been made as of this date.*