Employment Application Step 1 of 4 25% Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Date Available* MM slash DD slash YYYY Social Security Number It is safe to enter your personal information here. This form is secure and your data is encrypted. This field is optional, you can come into a branch to give us this information if you would prefer.Desired Salary Position Applying For* Customer Service Representative - FT - Ouray, CO Do you understand that you are applying for a job located in Colorado?* Yes We are located in South Western Colorado. We are NOT located in Oregon or Pennsylvania.Hours Available to Work Days Available to Work Availability Full Time Part Time Are you authorized to work in the U.S.?* Yes No Have you ever worked for this company?* Yes No If yes, when?*Do you have relatives working for this company?* Yes No If yes, who?*Have you been convicted of or plead guilty (includes deferred judgement and no contest plea) to a crime or subjected to a court martial? (Do not include crimes for which public records are sealed or have been expunged)* Yes No If Yes, identify the nature of the offense, county and state where convicted, date of conviction, and sentence or fine imposed:*If you are presently charged with committing a criminal offense, identify the nature of offense, county and state where charges are pending, and status of the charges EducationHigh School City/State Did you graduate?* Yes No When did you graduate?* College City/State Did you graduate?* Yes No Degree* When did you graduate?* Other City/State Did you graduate? Yes No Degree* When did you graduate?* Employment HistoryPlease list your last three jobs.Company 1* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor* Job Title* Responsibilities*When were you employed?* Reason for leaving?* May we contact your previous supervisor for a reference?* Yes No Company 2* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor* Job Title* Responsibilities*When were you employed?* Reason for leaving?* May we contact your previous supervisor for a reference?* Yes No Company 3* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor* Job Title* Responsibilities*When were you employed?* Reason for leaving?* May we contact your previous supervisor for a reference?* Yes No Skills*ReferencesPlease list three professional references.Name* First Last Phone*Address* Relationship* Company Name* First Last Phone*Address* Relationship* Company Name* First Last Phone*Address* Relationship* Company Previous Military ServiceAre you a veteran?* Yes No Branch* When did you serve?* Rank at Discharge* Type of discharge* If other than honorable, explainCertifications/Awards Disclaimer and ConsentPLEASE READ THE FOLLOWING PARAGRAPH BEFORE SIGNING THIS APPLICATION I certify that the following information in this application is correct to the best of my knowledge. I understand that any misrepresentation of information by statement or omission will result in disqualification or , if already hired, dismissal from employment, no matter when the misrepresentation is discovered. I authorize The Citizens State Bank of Ouray to contact my references, investigate my employment history, education, criminal record, and if applicable, driving record, and to obtain a consumer report regarding me. I agree to assist The Citizens State Bank of Ouray in obtaining background information on me by signing any authorization/release forms necessary to obtain such information. All employment with The Citizens State Bank of Ouray is at-will, meaning that employment with The Citizens State Bank of Ouray may be terminated, with or without cause, and with or without prior notice, at any time, at the option of either me of The Citizens State Bank of Ouray. I understand that no supervisor or manager has the authority to enter into an agreement for employment that waives The Citizens State Bank of Ouray’s right to terminate employment at-will. I understand that The Citizens State Bank of Ouray has policies and procedures that I must follow, if hired. I understand that The Citizens State Bank of Ouray reserves the right to change its policies and procedures, including personnel policies and employee benefits at any time without approval by employees, and that these changes are accepted by continuing my employment with The Citizens State Bank of Ouray. If offered employment, I will consider the offer, and if I accept, I will fulfill the requirements of the job to my best ability.Consent* By checking this, I certify all information is true and correct to the best of my knowledge.Untitled First Choice Second Choice Third Choice Untitled First Choice Second Choice Third Choice NameThis field is for validation purposes and should be left unchanged.
