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Employment Application

EMPLOYMENT APPLICATION
It is the policy of Alliance Bank to provide equal employment opportunity to all applicants and employees in harassment-free work environment without regard to race - religion - color - national origin - gender - age - disability - sexual orientation - alien status - veteran status or other status protected by law. Alliance Bank is an Equal Opportunity Employer.
STEP 1 - PERSONAL INFORMATION
Name:
Date of Application:
Address:
City State & Zip:
Phone Number:
Mobile/Other Phone Number:
Email Address:
Position Desired:
Salary or Hourly Rate of Pay Desired:
Office Location(s) Desired
Francesville:
Monon:
Monticello:
Otterbein:
Oxford:
Rensselaer:
Winamac:

Are you 18 years of age or older?:	Yes No
Are you legally eligible to work in the United States?:	Yes No
Have you ever filed an application with Alliance Bank before?:	Yes No
If Yes give date of application:
Have you ever been employed at Alliance Bank before?:	Yes No
If Yes give dates of employment and office location:
Does your present employer know of your plans to change employment?:	Yes No N/A - Not currently employed
Why do you desire to make such a change?:
Are you available for work::	Full Time Part Time Temporary
Have you ever been bonded in a prior employment?:	Yes No
Has a previous bond coverage ever been modified or revoked? Or has a bond application been denied?:	Yes No
Have you ever pleaded guilty or no contest to - or been convicted of a crime?:	Yes No
If yes please provide date(s) and details:
Answering yes to the above question does not constitute an automatic bar to employment. Factors such as date of the offense - seriousness and nature of the violation - rehabilitation and position applied for will be taken into account.
Are you related to an employee of Alliance Bank?:	Yes No
If Yes who and how are you related:
Can you perform the duties of the job for which you are applying - with or without reasonable accommodation?:	Yes No
This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability - particular accommodation or whether accommodation is necessary. These issues may be addresses at a later date to the extent permitted by law.

STEP 2 - EDUCATION
High School
Name and Location of School:
Course of Study:
Number of Years Completed:	1 2 3 4
Did you Graduate?:	Yes No
Diploma or Degree Received:
Vocational or Trade School
Name and Location of School:
Course of Study:
Number of Years Completed:	1 2 3 4
Did you Graduate?:	Yes No
Diploma or Degree Received:
College
Name and Location of School:
Course of Study:
Number of Years Completed:	1 2 3 4
Did you Graduate?:	Yes No
Diploma or Degree Received:
Graduate School
Name and Location of School:
Course of Study:
Number of Years Completed:	1 2 3 4
Did you Graduate?:	Yes No
Diploma or Degree Received:
STEP 3 - EMPLOYMENT EXPERIENCE
Employer 1
Name of Employer:
Address:
Phone Number:
Supervisor:
Employment Dates
From:
To:
Job Title:
Describe the Work Performed:
Hours Worked per Week:
Reason for Leaving:
Employer 2
Name of Employer:
Address:
Phone Number:
Supervisor:
Employment Dates
From:
To:
Job Title:
Describe the Work Performed:
Hours Worked per Week:
Reason for Leaving:
Employer 3
Name of Employer:
Address:
Phone Number:
Supervisor:
Employment Dates
From:
To:
Job Title:
Describe the Work Performed:
Hours Worked per Week:
Reason for Leaving:
I hereby give my permission to contact the Employer(s) listed above concerning my prior employment experience as indicated below.
Employer 1:	Yes No
Employer 2:	Yes No
Employer 3:	Yes No
STEP 4 - REFERENCES
List names and phone numbers of three business/work references who are not related to you and whom you have known for at least one year.
Reference 1
Name:
Employment:
Address:
Phone Number:
Reference 2
Name:
Employment:
Address:
Phone Number:
Reference 3
Name:
Employment:
Address:
Phone Number:
STEP 5 - ADDITIONAL INFORMATION
Cover letter and/or resume may be emailed to: jhonn@myalliancebank.com Please reference date of online application in email.
Provide any further information that does not appear elsewhere in this application that you think would be helpful to use in considering you for employment - such as special skills - experience - education - training - research - accomplishments - articles published or other activities. Note: you may exclude any information that would reveal race - color - religion - sex - national origin - age or disability.
Additional Information:
STEP 6 - APPLICANT'S AGREEMENT
I UNDERSTAND AND AGREE THAT:
If I misrepresent or deliberately leave out a fact in my application - I may be refused employment or - if employed - I may be terminated. Alliance Bank may verify all of the information provided by me - including but not limited to - education and employment. Alliance Bank is hereby authorized to make any investigation of my personal history through any investigative bureaus of their choice. Alliance Bank is authorized to conduct any pre-employment tests and examinations. I hereby understand and acknowledge that - unless otherwise defined by applicable law - 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. It is further understood that this ‘at will’ employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. If employed - I understand that my employment is for no definite period of time - and if terminated - Alliance Bank is liable only for wages or salary earned as of the date of termination. I understand - also - that I am required to abide by all rules and regulations of this employer.
Signature of Acceptance:
Date: