ISPFCU - Employment Application

Education

High School

School Name
Address
Years Attended
Did you graduate?		Yes No

College

School Name
Address
Years Attended
Did you graduate?		Yes No
Subjects Studied

Trade, Business, or
Correspondence School

School Name
Address
Years Attended
Did you graduate?		Yes No
Subjects Studied

General

Subjects of Special Study or Research Work
Special Training
Special Skills

Former Employers

List below up to the last three employers, starting with the most recent first

Name of Present or Last Employer
Address
Starting Date
Leaving Date
Job Title
May we contact your supervisor?		Yes No
Name and Title of Supervisor
Phone
Description of Work
Reason for Leaving

Name of Previous Employer
Address
Starting Date
Leaving Date
Job Title
May we contact your supervisor?		Yes No
Name and Title of Supervisor
Phone
Description of Work
Reason for Leaving

Name of Previous Employer
Address
Starting Date
Leaving Date
Job Title
May we contact your supervisor?		Yes No
Name and Title of Supervisor
Phone
Description of Work
Reason for Leaving

References

Below, give the names of three persons you are not related to, whom you have known at least one year.

Name
Address
Phone
Business
Years Aquainted

Name
Address
Phone
Business
Years Aquainted

Name
Address
Phone
Business
Years Aquainted

Service Record

Branch of Service
Discharge Date
Rank

Have you been convicted of a felony in the past 5 years?		Yes No
If yes, explain. (Will not necessarily exclude you from consideration)

Authorization

"I certify that the facts contained in this application are true and to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."

Signature *

ISPFCU provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age or disability in accordance with applicable state and federal laws.

First Name *
Last Name *
Present Address *
Permanent Address *
Phone Number *
Email Address *
Are you 18 years or older?		Yes No

Position *
Date You Can Start *
Salary Desired *
Are you employed now?		Yes No
If so may we inquire of your present employer?		Yes No
Who referred you to this company?