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PLEASE READ THE FOLLOWING BEFORE FILLING OUT THIS APPLICATION FORM.

This bank is an equal opportunity employer and does not discriminate in recruiting, hiring, training, promoting or other employment practices for reasons of race; color; religion; sex; national origin; age; Veteran/Reserve, National Guard status; marital status or disability. No question in this application is intended to secure information to be used for such discrimination.

This application will be given every 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, it will be difficult to secure this bond and the bank may be unable to offer employment.

Please complete this form carefully and provide only the information requested. Replies to all questions will be held in strictest confidence.

Last Name First Middle Social Security # Phone
Cell Phone Email Address
Present Address City State   Zip From
Addresses for Last Five Years
  Street City State  Zip From To
1. 
2. 
3. 
4. 
5. 

Are you legally eligible to be employed in the United States?  
Are you 18 years of age or older?  
If needed, do you have the proper work permits?  
Position desired:
(Can only apply for open positions)
Closing Agent (Main Office)
Credit Analyst II - Main Office
P/T Float Service Specialist (Teller) M-F 11:00-4:30 (Float)
Personal Banker (Pinellas Plaza)
Personal Banker (Spruce Creek Office)
Switchboard Operator F/T or P/T (Main Office)
How soon could you report to work?  
Rate of pay expected:  
How did you come to apply?  
Newspaper Ad
Former Employee
High School Recruitment
College Recruitment
Employment Agency
Employee Referral
Name:
3rd Party Website
Name:
Have you ever been arrested, convicted, pled nolo contendre, had adjudication withheld or been placed on probation for a criminal offense, including but not limited to offenses involving dishonesty or breach of trust (such as robbery, embezzlement, forgery, perjury, tax evasion, shop lifting, etc.)? Responding Yes will not automatically disqualify you from employment.  
If so, state dates, place, courts, where offense occurred and judgement given:  
GIVE PERSONAL REFERENCES WHO ARE NOT RELATIVES OR FORMER EMPLOYERS
  Name Address Occupation Years
Known
1. 
2. 
3. 
4. 

Please Review Your Information Before Proceeding





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