Application for Employment

Personal Information

Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)? *

Please do not provide information about specific disabilities or whether accommodation is necessary.

Computer Skills

Employment History

References

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE YOUR UNDERSTANDING AND ACCEPTANCE BY SIGNING IN THE SPACE PROVIDED

I certify that all the information provided by me in connection with my application, whether on this document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information may be grounds for refusal to hire or, if hired, termination.

2.

I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability from any damages which may result from furnishing such information to you.

3.

I hereby waive any and all rights and claims I may have regarding JCB, its agents, employees or representatives, for seeking, gathering and using information in a lawful manner, in the employment process and all other persons for furnishing such information about me.

4.

I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

5.

I understand that as a condition of employment, I will be required to provide legal proof of authorization to work in the U.S. and the federal immigration laws require me to complete an I-9 Form in this regard.

6.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to eliminate me from further consideration for employment, or may result in my termination in employment when it is discovered.

JCB does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her race, color, religion, age, gender, national origin, disability, veteran status or any other protected status.

I certify that I have read, fully understand and accept all terms of the foregoing statements.

I authorize any reference, school, former employer, or other person to disclose to Jackson County Bank upon request any information they may have about me, and I release them from all liability for disclosing such information to Jackson County Bank. I understand that Jackson County Bank may include a criminal background history as well as a verification of my social security number as part of its retrieval of such reference information.

I authorize Jackson County Bank to obtain or cause to be prepared a consumer report and/or an investigative consumer report, which may include information as to my financial and credit worthiness, credit capacity, and credit standing in addition to my history, character, general reputation, personal characteristics or mode of living, in connection with my application for employment.

In order to assist with any request for information, I supply the following:

NOTE: The Federal Fair Credit Reporting Act defines "consumer report" to mean most background information needed for employment, and Section 604 of the Act (15 U.S.C. 1681b) requires us to give you the following notification before we can obtain information that is relevant to employment.

Jackson County Bank may receive a consumer report and/or an investigative consumer report, which includes information as to my credit worthiness, credit standing, and credit capacity in addition to my character, general reputation, personal characteristics and mode of living.

I understand that if I am denied employment based upon the contents of any investigative consumer report that I will be notified of the name, telephone number (including any toll-free number) and address of the reporting agency. I have been advised by JCB that I may make a written request, within 60 days of receiving notice of any adverse employment action that was based on the consumer investigative report, for a copy of the report. I understand that I will be provided a written summary of my rights under the Fair Credit Reporting Act as prepared by the Federal Trade Commission.

By signing below I acknowledge the above and understand that my application for employment will not be processed until this notice is signed.

I have received and kept a copy of this notice.

Resume Review

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