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Application for Employment

Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.
Attach Resume:
Or email a resume to HR@flnb.com
Position Applied for:
Referred by:

Applicant Information

First Liberty National Bank does not discriminate on any employment practice on the basis of race, religion, color, sex, age, national origin, marital status, veteran’s status, the presence of a non-job-related medical condition, or disability. No question on this application is intended to secure information which could be of a discriminatory nature.
*First Name: *Last Name: MI:
*Address: Apartment/Unit #
*City *State
Previous Address: Previous Apartment/Unit #
Previous City Previous State
Previous Zip
*Phone: Work Phone:
*Social Security Number: Do you have any relatives that are currently employed with FLNB?:    Yes    No
*Have you ever worked for this company?:  Yes     No If yes, when?:  to   (mm/dd/yyyy)
*Have you ever applied for employment with us?:  Yes     No If yes, when?:  to   (mm/dd/yyyy)
Are you currently employed?    Yes    No Are you authorized to work in the U.S.?:  Yes     No
Can you travel if the job requires it?    Yes    No Have you ever been bonded?  Yes     No
*Have you ever been convicted of, plead guilty, or no contest to a felony offense?
 Yes     No If yes, explain briefly:
Were you in the U.S. Armed Forces?    Yes    No If yes, what branch?
I can work:  Full Time    Part Time    Temporary    Shift Work    Overtime
*Date Available:

Employment History

Company Name: Complete Address
(w/ City, State, Zip):
Phone: Supervisor:
Job Title: Responsibilities:
Monthly Starting Salary: Monthly Ending Salary:
Start Date:
End Date:
Reason for Leaving: May we contact your previous employer for a reference?  Yes    No
Describe the skills and aptitudes you possess that would qualify you for a position with FLNB:


High School:   Address:
Graduate:    Yes     No   Degree:
Trade/Business School:   Address:
Graduate:    Yes     No   Degree:
College:   Address:
Graduate:    Yes     No   Degree:
Graduate Work/Other:   Address:
Graduate:    Yes     No   Degree:
Languages Known
Language    Speak    Read    Write   Fluency:  Good    Fair  
Language    Speak    Read    Write   Fluency:  Good    Fair  
Language    Speak    Read    Write   Fluency:  Good    Fair  

Personal References

Please list three references not related to you and who are not previous employers
Name: Occupation:
Years Known Phone Number:
Name: Occupation:
Years Known Phone Numbers:
Name: Occupation:
Years Known Phone Numbers:

Professional References

Please list three professional references.
Name: Occupation:
Years Known Phone Number:
Name: Occupation:
Years Known Phone Number:
Name: Occupation:
Years Known Phone Number:
Please list professional, trade, business, or civic associations and any offices held. (Exclude organizations which would reveal sex, race, religion, national origin, age, disability, veteran or other protected status.)
Organization Offices Held:
Organization Offices Held:
Organization Offices Held:
List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, disability, veteran or other protected status.)

Employment Data Record

First Liberty National Bank is an affirmative action employer, and does not discriminate, and is subject to Federal regulations requiring reporting of certain information on applicants for employment. To assist in this effort, all applicants are requested to complete this form. Your cooperation is strictly voluntary. This form will be kept separate from your employment application and the information contained will be kept confidential. It will not be available to personnel involved in the hiring process. The information given will be used only for reporting purposes in accordance with Federal laws and regulations.

If you do not wish to provide this information, please print your name, the date and please indicate such fact in the appropriate space below. Your decision in this regard will not affect your application.

Gender:    Male    Female
  Check here if you do not wish to provide the information requested below.
Date:   Position Applied For:
First Name: Last Name: MI:
Address: Apartment/Unit #
City State
Zip Social Security Number:
Race/Ethnic Categories (Check one):  White    Hispanic or Latino    Black or African American (not Hispanic or Latino)  
 Asian (not Hispanic or Latino)    Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)  
 American Indian/Alaskan Native (not Hispanic or Latino)    Two or More Races  
Disability Status (Check one):  Yes, I have a disability  
 No, I don't have a disability 

Applicant's Statement

Notification and Agreement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize the Bank to investigate all statements in this application and to secure any necessary information from all my employers, references and academic institutions. I authorize the Bank to investigate criminal court records and as a result I will be requested to complete an Authorization to Obtain Consumer and Investigative Consumer Report form.

I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my credit, academic credentials, and employment references. Because of amendments to the Fair Credit Reporting Act in 1997, I understand that extra procedures are required of the Bank. Thus, I will be notified as to those procedures if my application for employment necessitates a credit report. I further understand that any false information, misleading statements or omission of facts will be sufficient cause for rejection of my application if the Bank has not employed me and for immediate dismissal if the Bank has employed me.

In the event of my employment with the Bank, I will comply with all rules, regulations, and policies set forth in the Bank's policy manual or other communications distributed by the Bank. I understand the Bank promotes an alcohol/drug free workplace. I agree to abide by the guidelines set forth in the Bank's alcohol/drug abuse policy.

Further, I understand that I must immediately notify the Bank if I am convicted of, receive deferred adjudication in, or otherwise plead guilty or no contest to a felony, or any criminal offense involving dishonesty or a breach of trust or money laundering, while my application is pending or during my tenure as an employee of the Bank.

I understand that nothing in this employment application, in the Bank's policy statements or personnel guidelines, or in my communications with any Bank official is intended to create an employment contract between the Bank and me. I also understand that the Bank has the right to modify any of its policies without giving notice of the changes to me. No promises of employment have been made to me. I acknowledge that the Bank employs individuals under the employment-at-will doctrine and that this is not subject to any changes. I understand that if an employment relationship is established, I have the right to terminate my employment at any time for any reason. I also understand that the Bank retains the right to terminate my employment at any time for any reason.

I hereby acknowledge that I have read and understand the preceding statements.