EMPLOYMENT APPLICATION

Transcription

1 EMPLOYMENT APPLICATION BANK OF DENVER CORPORATE OFFICE 810 EAST 17 TH AVENUE DENVER, COLORADO BRANCHES GOLDEN TRIANGLE BRANCH 606 W. COLFAX (FOX & COLFAX)) DENVER, COLORADO LEETSDALE BRANCH 530 S. HOLLY (LEETSDALE & HOLLY) DENVER, CO UPTOWN BRANCH 800 E. 17TH AVENUE (17 TH AND CLARKSON) DENVER, COLORADO 80218

2 DISCLOSURE FAIR CREDIT REPORTING ACT DISCLOSURE AND AUTHORIZATION As an applicant for employment or a current employee of Bank of Denver, you are a consumer with rights under the Fair Credit Reporting Act. When any of the following circumstances exist, Bank of Denver may choose to obtain and use information contained in either a consumer report or an investigative consumer report from a consumer reporting agency about you: (1) when considering your application for employment (2) when making a decision whether to offer you employment, (3) when deciding whether to continue your employment (if you are hired), or (4) when making other employment-related decisions directly affecting you. For explanation purposes, a consumer reporting agency is a person or business which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing consumer reports to others, such as Bank of Denver. A consumer report means any written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing your eligibility for employment purposes. An investigative consumer report means a consumer report or portion thereof in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your neighbors, friends, or associates reported on or with others with whom you are acquainted or who may have knowledge concerning any such items of information. In the event an investigative consumer report is prepared, you may request additional disclosures regarding the nature and scope of the investigation requested as well as a written summary of your rights under the Fair Credit Reporting Act. AUTHORIZATION By signing below, I,, hereby voluntarily authorize Bank of Denver to obtain either a consumer report or an investigative report about me from a consumer reporting agency and to consider this information when making decisions regarding my employment at Bank of Denver. I understand that I have rights under the Fair Credit Reporting Act, including the rights discussed above. Name Date 1

3 APPLICANT DISCLOSURE AND AUTHORIZATION FORM Bank of Denver ( The Company ) may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a consumer report and/or an investigative consumer report which may include information about your character, general reputation, personal characteristics, and/or mode of living, which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ( driving records ), verification of your education or employment history including current position, worker s compensation injuries, or other background checks. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by 3rd Degree Screening, INC 100 East Broadway, Suite 201, Council Bluffs, IA 51503, or another outside organization. The scope of this notice and authorization is allencompassing, however, allowing Bank of Denver to obtain from any outside organization all manners of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report. ACKNOWLEDGMENT AND AUTHORIZATION I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by the Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by 3rd Degree Screening, INC 100 East Broadway, Suite 201, Council Bluffs, IA 51503, , another outside organization acting on behalf of Bank of Denver, and/or Bank of Denver. itself. I agree that a facsimile ( fax ), electronic or photographic copy of this Authorization shall be as valid as the original. New York applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by [Employer] by contacting the consumer reporting agency identified above directly. Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Company. California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law. Last Name First Middle Other Names/Alias Social Security* # Date of Birth* Driver s License # State of Driver s License Present Address Phone Number City/State/Zip_ All Previous Addresses in the Last Seven Years Signature: Date: Parant or Gaurdian (If Under 18 Years of Age) Signature: Date:

4 Para informacion en espanol, visite o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment or to take another adverse action against you must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your file disclosure ). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identify theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information. You have the right to ask for a credit score. Credit scores are numerical summaries of your creditworthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

5 Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to You may limit prescreened offers of credit and insurance you get based on information in your credit report. Unsolicited prescreened offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at XXX-XXXX. You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are: TYPE OF BU SINESS: Consumer reporting agencies, creditors and others not listed below National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name) Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name) Federal credit unions (words "Federal Credit Union" appear in institution's name) State-chartered banks that are not members of the Federal Reserve System Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act, 1921 CONTACT: Federal Trade Commission: Consumer Response Center - FCRA Washington, DC Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC Federal Reserve Board Division of Consumer & Community Affairs Washington, DC Office of Thrift Supervision Consumer Complaints Washington, DC National Credit Union Administration 1775 Duke Street Alexandria, VA Federal Deposit Insurance Corporation Consumer Response Center, 2345 Grand Avenue, Suite 100 Kansas City, Missouri Department of Transportation, Office of Financial Management Washington, DC Department of Agriculture Office of Deputy Administrator - GIPSA Washington, DC

6 Bank of Denver fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, disability, sexuality orientation, or any other basis prohibited by federal, state, or local law. In accordance with requirements of the Americans with Disabilities Act, it is our policy to provide reasonable accommodation upon request during the application process to eligible applicants in order that they may be given a full and fair opportunity to be considered for employment. As an Equal Opportunity Employer, we intend to comply fully with applicable federal and state employment laws and the information requested on this application will only be used for the purposes consistent with those laws. An application is only accepted for positions currently available and will only be considered for thirty (30) days from today s date or until the position applied for is filled, whichever first occurs. POSITION APPLIED FOR: DATE: Employment Desired: Full-Time Part-time Seasonal PERSONAL DATA Last name First Middle Social Security Number Street Address City State/Zip Code Telephone Number Are you at least 18 years old? Yes No If not, state your age for child labor law purposes only: Are there any days, shifts or hours you will not work? Yes No If yes, please explain: Will you work overtime, if required? Yes No When will you be able to start work? Have you taken any illegal drugs in the last 30 days? How did you learn of our Company? If referral, who were you referred by: Have you ever worked here before? Yes No If yes, provide date: Are you legally authorized to work in the Unites States? Yes No Will you now or in the future require sponsorship for employment visa status? Yes No NOTE: The Federal Immigration and Reform and Control Act of 1986 requires that an INS Employment Eligibility Verification Form I-9 be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing their identity and authorization for work. This federal requirement must be satisfied as a condition of employment. Have you been convicted of a felony within the last seven years? Yes No Date of Conviction: NOTE: Answering yes does not automatically exclude you from further consideration for the position. If yes, please explain on the Additional Comments section, including penalty imposed. Have you been convicted within the last seven years of misappropriation of funds, embezzlement or other dishonest conduct, an offense involving the use of a weapon, physical assault or other violent crimes? Yes No If yes, please explain on the Additional Comments section, including penalty imposed. NOTE: Answering yes does not automatically exclude you from further consideration for the position. Have you ever been a defendant in a civil action for an intentional tort (intentional commission of a wrongful act)? Yes No If yes, include the nature of the intentional tort and the disposition of the action in the 4

7 Additional comments section. NOTE: Answering yes does not automatically exclude you from further consideration for the position. DRIVING RECORD (Answer only if driving is a requirement of the job for which you are applying) Do you have a valid driver license? Yes No State License Number: Have you had any tickets? Yes No If yes, please explain Has your license ever been suspended or revoked? Yes No If yes, please explain Do you have any DUI or DWI convictions? Yes No If yes, please state when you were convicted and explain: EDUCATION (May or may not be considered depending on job applied for) Describe any educational degrees, skills, training, or experience you believe are relevant to the job applied for: Name, City and State of Educational Institute High School: Type of Degree Graduated: If no Degree, Credits earned received or Expected Major Minor Grade Point Yes No Overall GPA College or University: Technical/GED/Other Licenses, Certifications/Other 5

8 EMPLOYMENT HISTORY (Please complete for all full-time or part-time employment beginning with most recent employer) Company Name: Telephone Number: Address: Name of Supervisor: State job titles and describe job duties: May we contact? Yes No Dates Employed From: To: Rate of Pay Start: $ Last: $ Reason for leaving: Company Name: Address: Name of Supervisor: State job titles and describe job duties: Reason for leaving: May we contact? Yes No Telephone Number: Dates Employed From: To: Rate of Pay Start: $ Last: $ Company Name: Address: Name of Supervisor: State job titles and describe job duties: Reason for leaving: May we contact? Yes No Telephone Number: Dates Employed From: To: Rate of Pay Start: $ Last: $ 6

9 REFERENCES: Please list three persons not related to you who know your qualifications. NAME ADDRESS PHONE RELATIONSHIP Please explain any gaps in your employment history. Have you ever been discharged or forced to resign? Yes No If yes, explain: Did you receive any discipline in the last 12 months of active employment? Yes No If yes, explain: Were you given a performance evaluation within the last 12 months of active employment? Yes No If yes, what was the range of scores used and what was your score? Have you signed any non-compete or non-solicit agreement with any other employer that might restrict you from working for this company? Yes No If yes, please explain: (You may be required to furnish a copy of the agreement.) MILITARY (Complete only if you served in the military.) Branch of Service: Number of Years/Months of Service: Rank at Discharge: Reason for leaving: Describe any military skills, training or experience you believe are relevant to the job applied for: 7

10 APPLICANT S ACKNOWLEDGMENT I certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of fact or incomplete answers in any application document will disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document may be cause for my dismissal at any time without prior notice. I consent to and authorize Bank of Denver to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references to give Bank of Denver (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party(ies) for providing a good faith reference. I expressly agree and understand that, if employed, my employment is not for a specific term, is based on mutual consent and may be terminated by me or my employer(s) with or without notice or cause at any time. I further understand that no oral promise, employer(s) policy, custom, business practice or other procedure (including the personnel handbook or any personnel manuals) constitute an employment contract or modification at the at-will employment relationship between me and the employer(s). I also understand that this aspect of my employment may not change absent an individual written agreement signed by both the bank president and me. I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver s examination; submit to a background investigation; take a pre-employment drug test. If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all required tests. I authorize the release of any background check results of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document. I acknowledge that this application will remain active for 30 days from this date. If I have not heard from Bank of Denver at the conclusion of this 30 day period, it is my responsibility to complete a new application if I still wish to be considered for employment. Signature Date 8