Employment Application SECTION A PERSONAL INFORMATION Personal information Position you are applying for: First name: MI: Last name: Your home address: City: State: Zip code: Day time phone number: Home phone number: Cell/Pager number: Social Security Number: Type of employment? Full Time   Part Time How did you learn of this job opportunity? Website Newspaper Friend Employee Please choose branches where you are willing to work:   Main Round Rock Barton Springs I can work at any location Have you previously applied for a postion at Velocity? Yes   No Minimum salary: Are you at least 18 years old? Yes   No Are you authorized to work in the U.S. on an unrestricted basis? (Proof of identity and eligibility to work in the U.S. will be required upon employment)   Yes   No Are you related to any member of the Board of Directors, or employee of this credit union?   Yes   No If yes, Name: Relationship: Have you ever been convicted of a felony or sentenced to deferred adjudication for a felony ofense?   Yes   No If yes, describe conditions: Are there any hours you cannot work? Yes   No If yes, explain: If overtime is required, will you be willing and able to accomodate? Yes   No If no, explain: Section B Education High School attended: University attended: University attended (if needed): Highest grade successfully completed. High School/GED Associate's Degree Bachelor's Degree Master's Degree Office/Other Applications Section C Employment History FIRST EMPLOYER May we ask your current employer for a reference? Yes   No Name of Employer: Address: City: State: Zip code: Phone number: Your Position: Duties: Date employed: Date Left: Starting Salary: Final Salary: Reason for Leaving: SECOND EMPLOYER Name of Employer: Address: City: State: Zip code: Phone number: Your Position: Duties: Date employed: Date Left: Starting Salary: Final Salary: Reason for Leaving: THIRD EMPLOYER Name of Employer: Address: City: State: Zip code: Phone number: Your Position: Duties: Date employed: Date Left: Starting Salary: Final Salary: Reason for Leaving: Section D Resume Copy your Resume here SECTION E REFERENCES 1st REFERNCE Name: Address: State: Zip code: Phone number: 2nd REFERNCE Name: Address: State: Zip code: Phone number: 3rd REFERNCE Name: Address: State: Zip code: Phone number: Applicants Certification and Agreement I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements may result in dismissal. I authorize Velocity Credit Union to make an investigation of any of the facts set forth in this application, and my financial and credit record through any investigative, credit agencies or bureaus of the Credit Union's choice. Public Law 91-508 requires that we advise you that a routine inquiry may be made that will provide applicable information concerning character, general reputation, personal characteristics, and mode of living. On written request, additional information as to the nature and scope of the report, if one is made, will be provided. I understand that this application is the property of Velocity Credit Union and will become a part of my confidential personnel file if I am accepted for employment. I understand that employment at Velocity Credit Union is "at will", which means that either I or the Credit Union can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by law. All employment is continued on that basis. I understand that no supervisor, manager, or executive of the Credit Union has any authority to alter the foregoing. I have read the above statement and:   I Agree I Disagree I understand that Velocity Credit Union may request information from public and private sources about my: court record, education, credentials, credit and references. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by Velocity Credit Union, or its agent, to furnish this information.   I Agree I Disagree   Consumer Credit Report VELOCITY CREDIT UNION MAY OBTAIN A CONSUMER CREDIT REPORT ON ANY JOB APPLICANT FOR EMPLOYMENT PURPOSES. WRITTEN AUTHORIZATION TO OBTAIN THIS REPORT IS INCLUDED ON THE EMPLOYMENT APPLICATION. By your affirmative selection below, you hereby authorize us to obtain a consumer report about you in order to consider you for employment.   Yes   No   Affirmative Action Survey Velocity Credit Union is an equal opportunity employer. Qualified applicants are considered for employment without regard to race, color, religion, national origin, age, sex, marital status, pregnancy or parenthood, mental or physical disability, veteran status, or any other protected status. To help us comply with federal equal opportunity record keeping requirements, please answer the questions on this survey. The information you provide will assist us in ensuring that all protected classes are represented in our applicant population. This data is for government reporting. Completion of this data is VOLUNTARY and will in no way affect employment with Velocity Credit Union. This survey will be separated from the remainder of the application form, and maintained in a separate file; and will not be reviewed by the individual making the employment decision. Position you are applying for: Please indicate the appropriate category for your sex and ethnic background:   Please Choose White Male White Female Black Male Black Female Hispanic Male Hispanic Female Asian Male Asian Female Native American Male Native American Female Other Other: Please mark any applicable protected-class categories: Vietnam Era Veteran Disabled Disabled Veteran

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