State Employees Credit Union Application for Employment

State Employees Credit Union Application for Employment Note: Application must be handwritten. Do not type. We appreciate your interest in our organization. Please complete the application as fully as possible. Applicants are considered for available positions without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, genetic information, veteran status, disability or other classification protected by law. To be considered as an applicant, you must designate the particular available position for which you are seeking employment. Position applied for: Applicant source: (check one) Date of application: 1 = Walk in 3 = Friend 5 = Advertisement 7 = School/College 9 = Other Explain 2 = Job Service 4 = Relative 6 = Employment Agency 8 = Job Posting Personal Data Last Name: First Name: Middle Initial: Address: City: State: Zip: Home Telephone: ( ) Social Security Number: --- --- If employed and under 18, can you furnish a work permit? Have you filed an application here before? Have you ever been employed here before? Have you ever been bonded? Have you ever refused bond? If yes, give date: Are you legally eligible to work in the United States? (SECU will require proof of citizenship or immigration status upon employment. SECU does not participate in the H1B or TN Visa programs.) Do you have any relatives employed with the State Employees Credit Union? If yes, please list them and their relationship to you: Your Job Requirements Salary desired: When could you be available to begin work? Are you willing to relocate anywhere in the state? Can you travel if a job requires it? Check appropriate box for type of employment: Full-time Peak-time Summer The following conditions may be required at some point in a job assignment. If required, would you be willing to work: a. shift work? b. overtime work? Education c. a work schedule other than Monday through Friday? d. a rotational work schedule? e. fluctuating hours? High School Business/Technical School College Graduate School School name and location Years completed 9 10 11 12 1 2 3 4 1 2 3 4 1 2 3 4 Diploma/Degree Earned

Activities & Offices List professional, trade business or civic activities and offices held. (You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, disability, or other protected status.) Work Experience List the last three positions you have held beginning with the most recent, or all the positions held in the last three years. If you do not have enough space, you may give more complete and detailed information on additional pages. Accuracy of dates and addresses is essential. Present or Last Employer Description of Work Address Position Reason for Leaving Dates of Employment From: To: Starting Salary Final Salary Supervisor s Name and Title Telephone No. Present or Last Employer Description of Work Address Position Reason for Leaving Dates of Employment From: To: Starting Salary Final Salary Supervisor s Name and Title Telephone No. Present or Last Employer Description of Work Address Position Reason for Leaving Dates of Employment From: To: Starting Salary Final Salary Supervisor s Name and Title Telephone No. Do you have any commitments to another employer or organization which might affect your employment with us? If yes, please explain: References Give name, address and telephone number of three references who are not related to you and who are not previous employers. 1. 2. 3. Applicant s Certification and Agreement Please read carefully before signing. The information that I have provided on this application is complete and accurate to the best of my knowledge and subject to validation by the Credit Union. I understand that any misleading or incorrect statement or omissions may render it void, and if I am employed, be cause for immediate dismissal at any time during my employment. I authorize all persons, schools, employers, and other organizations to provide the Credit Union with any relevant information that may be required to arrive at an employment decision. I hereby release these employers and individuals from all liability for any damage incurred in furnishing such information. In processing this employment application, I understand that State Employees Credit Union will request that an investigative or Credit Bureau report be prepared. This report will include a Criminal Record Report and may include information as to my character and general reputation. Each staff member must be approved and accepted for bonding by a surety company designated by the Credit Union in order to continue employment. In signing this application I authorize the Credit Union to supply my employment record in whole or in part, and in confidence to any prospective employer, government agency, or other party with a legal interest. 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. I further agree to comply with all policies of State Employees Credit Union. Signature of Applicant: Date: SECU 441 (12/17)

CONSUMER REPORT FOR EMPLOYMENT PURPOSES I hereby authorize State Employees Credit Union to obtain a consumer report and a criminal records search from a consumer reporting agency for employment purposes only. If I am hired by the State Employees Credit Union, this authorization will be valid during my employment. I also authorize FirstPoint to perform a criminal records search. I understand that FirstPoint does not guarantee the accuracy or timeliness of the information obtained from other sources and that FirstPoint will not be liable for any inaccuracy in the information obtained from other sources that are included in the INSIGHT report. Signature of Applicant: Date: FOR INTERNAL USE ONLY Account Number: Name (Please Print): Current Address: Social Security Number: Birth Date: SECU 709 (Revised 07/07/16)

PRE-OFFERVOLUNTARYSELF-IDENTIFICATION EEO / AFFIRMATIVE ACTION INFORMATION SECU provides equal employment opportunity to all qualified persons regardless of race, color, religion, age, genetics, sex, sexual orientation, gender identity, national origin, disability, veteran status or other classification protected by law. This policy is applied to all employment actions including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training including apprenticeship. State Employees Credit Union is required by law to document demographic information of applicants for affirmative action reporting. Completion of this form is voluntary, and participation or refusal of participation will not affect the hiring decision. Please complete the following and submit with your application. Last Name: First Name: Date: Position Applied For: GENDER Male Female RACE/ETHNICITY Hispanic or Latino If not Hispanic or Latino: White Black or African American Native Hawaiian or Pacific Islander Asian American Indian or Alaska Native Two or More Races VETERAN STATUS I identify as one or more of the classifications of protected veteran listed below I am not a protected veteran I do not wish to self-identify Signature: *See next page for EEOC Race/Ethnic identification category definitions and protected veteran classifications* April 21, 2015

EEOC/Race/Ethnic Identification Categories Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race White A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands. Asian A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. American Indian or Alaska Native A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races All persons who identify with more than one of the above five races. Protected Veteran Classifications A disabled veteran is one of the following: a veteran of the US 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 a person who was discharged or released from active duty because of a service-connected disability. A recently separated veteran means any veteran during the three-year period beginning on the date of such veteran s discharge or release from active duty in the US military, ground, naval or air service. An active duty wartime or campaign badge veteran means a veteran who served on active duty in the US military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An Armed forces service medal veteran means a veteran who, while serving on active duty in the US military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. Protected veterans may have additional rights under USERRA the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Dept of Labor s Veterans Employment and Training Service (VETS) at 1-866-4-USA-DOL. April 21, 2015

Voluntary Self-Identification of Disability Why are you being asked to complete this form? Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2020 Page 1 of 2 Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. i 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 fear 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 Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation) Please check one of the boxes below: YES, I HAVE A DISABILITY (or previously had a disability) NO, I DON T HAVE A DISABILITY I DON T WISH TO ANSWER Your Name Today s Date

Voluntary Self-Identification of Disability Reasonable Accommodation Notice Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2020 Page 2 of 2 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. i 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 Contract 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.

Nationwide Mortgage Licensing System Disclosure I agree to disclose if I have ever been registered with the Nationwide Mortgage Licensing System (NMLS) and will provide my NMLS ID. I agree to disclose any administrative, criminal or civil findings made by any government jurisdiction once I have been offered employment. If I am hired by the State Employees Credit Union, this authorization will be valid during my employment. Signature of Applicant: Date: 07/07/16