BANK USE ONLY Interviewed By: Date: Position: Location/Dept: www.norwaysavingsbank.com Hiring Exceptions: DOH: Salary: Authorized By: APPLICATION FOR EMPLOYMENT Complete, print, sign and return to: Human Resources Department Norway Savings Bank P.O. Box 347 Norway, ME 04268-0347 Fax 207.739.6189 PLEASE READ BEFORE FILLING OUT THIS APPLICATION The Bank does not discriminate, or tolerate discrimination, in hiring or employment on the basis of race, religion, color, gender, gender identity or expression, age, national origin, sexual orientation, genetic information, disability, or military/veteran s status. No question on this application is intended to secure information to be used for such discrimination. This application will be given fair consideration, but its receipt does not imply that the applicant will be employed. The Bank, at its own expense, arranges for a surety bond for each of its employees. Unless the applicant s background is acceptable to a surety company (under standards that do not discriminate on an illegal basis), it will be difficult to secure this bond and the Bank may be unable to offer employment. If you require accommodation of a disability in order to complete this application, please request it. In processing this employment application, the Bank may request that a consumer credit report and/or a criminal background check be ordered to evaluate the applicant s credit standing. You may request the names of the reporting agencies from the Human Resources Department, in writing, and within 5 days of your request, you will be provided the names and addresses of those agencies. You are entitled to receive copies of such reports from the agency. I hereby acknowledge that I have read and understand the foregoing disclosure. Signature: Date: PERSONAL INFORMATION Please Answer Every Question and Print Name. Use Ink. Name: First, Middle, Last Email Address Street Address: Length Of Time At This Address: City, State, Zip: Phone: List Previous Address Within The United States, Except Military, If Address Changed During The Past 5 Years. Street Address: City, State, Zip: Date: From To Street Address: City, State, Zip: Date: From To POSITION INFORMATION Position Applying For: Salary requirements: Applying for: q part-time q full-time q summer employment Date available to work: What days are you available? q Monday/Hours: q Wednesday/Hours: q Friday/Hours: Total weekly hours you wish to work: q Tuesday/Hours: q Thursday/Hours: q Saturday/Hours: Preferred locations/areas: (See Back Page For Full Addresses) q Auburn q Bethel q Bridgton q Brunswick - Maine Street q Brunswick - Cooks Corner q Falmouth q Freeport q Fryeburg q Gorham q Kennebunk q Naples q Norway (Main Office) q Portland - Congress St. q Portland - Exchange St. q Saco q Scarborough q South Paris q South Portland q Standish q Topsham q Windham q Yarmouth
EDUCATION PREP/HIGH SCHOOL: Years Completed: q 1 q 2 q 3 q 4 Degree: Address: Major or Course of Study BUSINESS/TECHNICAL SCHOOL: Years Completed: q 1 q 2 q 3 q 4 Degree: Address: Major or Course of Study COLLEGE: Years Completed: q 1 q 2 q 3 q 4 Degree: Address: Major or Course of Study GRADUATE WORK: Years Completed: q 1 q 2 q 3 q 4 Degree: Address: Major or Course of Study If you wish you may list scholastic honors, offices held, and/or extracurricular activities in which you participated that relate to the position you are seeking. Are you planning to pursue further studies? q Yes q No q Day school q Night school If so, when, where and what courses? What AIB/CFT or sales courses have you completed? Professional licenses or certification: EMPLOYMENT RECORD Starting with PRESENT or MOST RECENT, list four (4) previous employers. Include self-employment, summer, and part-time jobs. If presently employed, why do you desire to change your position? May we contact your present employer? q Yes q No If yes, name and telephone of contact:
PROFESSIONAL, TRADE, BUSINESS OR CIVIC ACTIVITIES OR OFFICES HELD You may exclude memberships or roles that indicate gender, race, religion, national origin, age, ancestry, disability or other protected status. PERSONAL REFERENCES PLEASE PRINT. Give three personal references who are mature persons, business or professional men or women of good standing in their community, and who have known you well during the past three or more years. You may include the names of friends or acquaintances presently employed by Norway Savings Bank, but do not name relatives, former employers or fellow employees. PLEASE READ BEFORE SIGNING If you have any questions regarding this statement, please ask them of an employment interviewer before signing. In the event of my employment with the Bank, I will comply with all rules and regulations as set forth in the Bank s policies and other communications distributed to employees. Additionally, I authorize the Bank to supply my employment record, in whole or in part, and in confidence, to government agencies, or any other party with a legal and proper interest. I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that any misrepresentation or omission may result in your refusal to hire me, or termination of my employment if discovered after hire. I understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the Bank in any way if the Bank decides to employ me. I understand and agree that my employment is at-will and can be terminated by either party at any time without notice, for any reason, or no reason, and that my at-will status is not affected by any representations, statements, promises or policies, other than a written employment contract authorized by the Board of Directors and signed by the President. I hereby acknowledge that I have read and understand the above statement. Signature: Date: SKILLS / BACKGROUND Check ONCE the lines of work in which you have had training, and TWICE those in which you are especially qualified. q q Calculator q q CRT/Data Entry Terminal q q Accounting q q Personal Computer q q Switchboard q q Typing q q Words/Minute Experienced in the following computer programs:
GENERAL INFORMATION Use the space below to describe your interest in banking and the skills and aptitudes you feel qualify you for a position at the Bank. (You may wish to include special training or skills such as sales, typing, accounting, project leadership, and the like.) If you need more space, please continue on a separate sheet. Is a member of your family currently employed here? q Yes q No If yes, name and relationship: Have you ever been interviewed here before? q Yes q No Have you been employed here previously? q Yes q No Were you employed under a different name? q Yes q No When were you employed here? Under what name? Have you ever been found guilty of a criminal offense involving dishonesty or breach of trust (including but not limited to robbery, embezzlement, forgery, perjury, tax evasion, etc.)? or any other crime? q Yes q No Explain: Have you ever been bonded? q Yes q No By whom? How were you referred to us? q Ad q Agency q Other q Employee (give name): Where did you see the ad? Are you a United States citizen? q Yes q No If no, give alien reg. #: NORWAY SAVINGS BANK BANKING OFFICES Auburn: 31 Court Street, Auburn ME 04210 Bethel: One Parkway, Suite 100, Bethel, ME 04217 Bridgton: 1 Harrison Road, Bridgton, ME 04009 Brunswick: 83 Maine Street, Brunswick, ME 04011 Brunswick - Cooks Corner: 14 Gurnet Road, Brunswick, ME 04011 Falmouth: 266 U.S. Route 1, Falmouth, ME 04105 Freeport: 8 Mallett Drive, Freeport, ME 04032 Fryeburg: 557 Main Street, Suite A, Fryeburg, ME 04037 Gorham: 65 Main Street, Gorham, ME 04038 Kennebunk: 68 Portland Road, Kennebunk ME 04043 Naples: 621 Roosevelt Trail, Naples, ME 04055 Norway (Main Office): 261 Main Street, Norway, ME 04268 Portland - Congress Street: 1200 Congress Street, Portland, ME 04102 Portland - Exchange Street: 120 Exchange Street, Portland, ME 04101 Saco: 569 Main Street, Saco, ME 04072 Scarborough: 158 U.S. Route 1, Scarborough ME 04074 South Paris: 7 High Street, South Paris, ME 04281 South Portland: 207 Waterman Drive, South Portland, ME 04106 Standish: 88 Ossipee Trail East, Standish, ME 04084 Topsham: 47 Topsham Fair Mall Road, Topsham, ME 04086 Windham: 10 Franklin Drive, Windham, ME 04062 Yarmouth: 688 U.S. Route 1, Yarmouth, ME 04096
Equal Employment Opportunity is THE LAW Private Employers, State and Local Governments, Educational Institutions, Employment Agencies and Labor Organizations Applicants to and employees of most private employers, state and local governments, educational institutions, employment agencies and labor organizations are protected under Federal law from discrimination on the following bases: RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN Title VII of the Civil Rights Act of 1964, as amended, protects applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy), or national origin. Religious discrimination includes failing to reasonably accommodate an employee s religious practices where the accommodation does not impose undue hardship. DISABILITY Title I and Title V of the Americans with Disabilities Act of 1990, as amended, protect qualified individuals from discrimination on the basis of disability in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. Disability discrimination includes not making reasonable accommodation to the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or employee, barring undue hardship. AGE The Age Discrimination in Employment Act of 1967, as amended, protects applicants and employees 40 years of age or older from discrimination based on age in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. SEX (WAGES) In addition to sex discrimination prohibited by Title VII of the Civil Rights Act, as amended, the Equal Pay Act of 1963, as amended, prohibits sex discrimination in the payment of wages to women and men performing substantially equal work, in jobs that require equal skill, effort, and responsibility, under similar working conditions, in the same establishment. GENETICS Title II of the Genetic Information Nondiscrimination Act of 2008 protects applicants and employees from discrimination based on genetic information in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. GINA also restricts employers acquisition of genetic information and strictly limits disclosure of genetic information. Genetic information includes information about genetic tests of applicants, employees, or their family members; the manifestation of diseases or disorders in family members (family medical history); and requests for or receipt of genetic services by applicants, employees, or their family members. RETALIATION All of these Federal laws prohibit covered entities from retaliating against a person who files a charge of discrimination, participates in a discrimination proceeding, or otherwise opposes an unlawful employment practice. WHAT TO DO IF YOU BELIEVE DISCRIMINATION HAS OCCURRED There are strict time limits for filing charges of employment discrimination. To preserve the ability of EEOC to act on your behalf and to protect your right to file a private lawsuit, should you ultimately need to, you should contact EEOC promptly when discrimination is suspected: The U.S. Equal Employment Opportunity Commission (EEOC), 1-800-669-4000 (toll-free) or 1-800-669-6820 (toll-free TTY number for individuals with hearing impairments). EEOC field office information is available at www.eeoc.gov or in most telephone directories in the U.S. Government or Federal Government section. Additional information about EEOC, including information about charge filing, is available at www.eeoc.gov.
Employers Holding Federal Contracts or Subcontracts Applicants to and employees of companies with a Federal government contract or subcontract are protected under Federal law from discrimination on the following bases: RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN Executive Order 11246, as amended, prohibits job discrimination on the basis of race, color, religion, sex or national origin, and requires affirmative action to ensure equality of opportunity in all aspects of employment. INDIVIDUALS WITH DISABILITIES Section 503 of the Rehabilitation Act of 1973, as amended, protects qualified individuals from discrimination on the basis of disability in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. Disability discrimination includes not making reasonable accommodation to the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or employee, barring undue hardship. Section 503 also requires that Federal contractors take affirmative action to employ and advance in employment qualified individuals with disabilities at all levels of employment, including the executive level. DISABLED, RECENTLY SEPARATED, OTHER PROTECTED, AND ARMED FORCES SERVICE MEDAL VETERANS The Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, 38 U.S.C. 4212, prohibits job discrimination and requires affirmative action to employ and advance in employment disabled veterans, recently separated veterans (within three years of discharge or release from active duty), other protected veterans (veterans who served during a war or in a campaign or expedition for which a campaign badge has been authorized), and Armed Forces service medal veterans (veterans who, while on active duty, participated in a U.S. military operation for which an Armed Forces service medal was awarded). RETALIATION Retaliation is prohibited against a person who files a complaint of discrimination, participates in an OFCCP proceeding, or otherwise opposes discrimination under these Federal laws. Any person who believes a contractor has violated its nondiscrimination or affirmative action obligations under the authorities above should contact immediately: The Office of Federal Contract Compliance Programs (OFCCP), U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210, 1-800-397-6251 (toll-free) or (202) 693-1337 (TTY). OFCCP may also be contacted by e-mail at OFCCP-Public@dol.gov, or by calling an OFCCP regional or district office, listed in most telephone directories under U.S. Government, Department of Labor. Programs or Activities Receiving Federal Financial Assistance RACE, COLOR, NATIONAL ORIGIN, SEX In addition to the protections of Title VII of the Civil Rights Act of 1964, as amended, Title VI of the Civil Rights Act of 1964, as amended, prohibits discrimination on the basis of race, color or national origin in programs or activities receiving Federal financial assistance. Employment discrimination is covered by Title VI if the primary objective of the financial assistance is provision of employment, or where employment discrimination causes or may cause discrimination in providing services under such programs. Title IX of the Education Amendments of 1972 prohibits employment discrimination on the basis of sex in educational programs or activities which receive Federal financial assistance. INDIVIDUALS WITH DISABILITIES Section 504 of the Rehabilitation Act of 1973, as amended, prohibits employment discrimination on the basis of disability in any program or activity which receives Federal financial assistance. Discrimination is prohibited in all aspects of employment against persons with disabilities who, with or without reasonable accommodation, can perform the essential functions of the job. If you believe you have been discriminated against in a program of any institution which receives Federal financial assistance, you should immediately contact the Federal agency providing such assistance. EEOC 9/02 and OFCCP 8/08 Versions Useable With 11/09 Supplement EEOC-P/E-1 (Revised 11/09)