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Oconee State Bank, Watkinsville, GA

Employment Application

Have you ever been employed by us before *, required
Type of employment desired *, required
Are you related to any employee of the bank *, required
Are you legally eligible for employment in this country? *, required
If you are under 18 can you furnish a Work Permit if required?

This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by the law.

Are you able to perform the essential functions of the job for which you are applying? *, required
Employment History - Please provide the following information, starting with your most recent employer:
Most Recent Employer
May we contact your employer?

Second Most-Recent Employer
May we contact your employer?

Third Most-Recent Employer
May we contact your employer?

Educational Background
High School

Under-graduate School

Graduate School

Other School

References

Give Work References. If Work References Are Not Available, Please Provide Personal References. These References Should Not Be Related To You Nor be Previous Supervisors.

Reference One

Reference Two

Reference Three

I certify that all information I have provided in order to apply and obtain work with Oconee State Bank is true, correct and complete and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I expressly authorize, without reservation, Oconee State Bank, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive all rights and claims I may have regarding the employer, its agencies, employees or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner in the employment process and all other persons, corporations or organizations for furnishing information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable, local, state or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

This application is valid for a period of 60 days from the date signed and shall not be considered thereafter unless renewed.

I understand that misrepresentation or omission of facts is cause for disqualification from further consideration for hire or may result in my immediate discharge form the employer’s service, whenever is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. My typed signature below constitutes and electronic signature and will be considered to be the legal equivalent of a handwritten, original signature.


Voluntary Self-Identification of Disability

Why are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. 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. 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, Autism, Bipolar Disorder, Post-traumatic stress disorder (PTSD), Deafness, Cerebral palsy, Major depression, Obsessive compulsive disorder, Cancer, HIV/AIDS, Multiple sclerosis (MS), Diabetes, Schizophrenia, Missing limbs or partially missing limbs, Impairments requiring the use of a wheelchair, Epilepsy, Muscular dystrophy, Intellectual disability (previous called mental retardation).

Please check on of the following options below *, required

Reasonable Accommodation Notice

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.

¡ 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.


Oconee State Bank Applicant Data Record

Applicants and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap/disability, or any other legally protected status. We comply with government regulations, including affirmative action responsibilities where they apply. Solely to help us comply with governmental record keeping, reporting and other legal requirements, we request that you please fill out the Applicant Data Record. We appreciate your cooperation. The data is for periodic government reporting and will be kept in a confidential file. YOUR COOPERATION IS VOLUNTARY.

Referral Source

CONFIDENTIAL INFORMATION VOLUNTARY SURVEY

Various government agencies request statistical information regarding our hiring practices. Your cooperation in completing this form is completely voluntary. Any information gathered is strictly confidential and will not subject you to coercion or intimidation relating to your status. Failure to provide this information will not adversely affect your application. Thank you for your cooperation.

Please check one
Check one of the following Race / Ethnic group
If Native American Indian, check if any of the following is applicable
I am a disabled veteran
I am an armed forces service medal veteran
I am a recently separated veteran
I am an active duty wartime or campaign badge (other protected) veteran

Definitions:

1. A Disabled Veteran means (i) a veteran of the U.S. 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 (ii) a person who was discharged or released from active duty because of a service-connected disability. :

2. Armed Forces Service Medal Veteran means a veteran who, while serving on active duty in the U.S. 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 (61 Fed. Reg. 1209) at http://www.fedshirevets.gov/hire/hrp/vetguide/index.aspx:

3. Recently Separated Veterans means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service. :

4. Active Duty Wartime or Campaign Medal (Other Protected) Veterans means a veteran who served on active duty in the U.S. military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized. For those with Internet access, the information required to make this determination is available at http://www.fedshirevets.gov/hire/hrp/vetguide/index.aspx.:

* asterisks mean Required
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