APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

We do not discriminate on the bases of race, color, religion, national origin, sex, sexual orientation, age, disability, or any prohibited basis. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Each question should be answered fully and accurately. No action can be taken on this application until all questions have been answered. None of the questions intend to imply illegal preferences or discrimination based upon non-job-related information.

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(If you are hired you may be to submit proof of age.)
















(A "Yes" answer does not automatically disqualify you from employment, because the nature of the offense, date, and the position for which you are applying will also be considered.)





For Teller and Special Accounts positions only: Do you have a valid driver's license?

List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.)







  School # Years Completed Diploma / Degree / Certificate Subjects Studied
High School or GED:
College or University:
Vocational or Technical:

What skills or additional training do you have that are related to the job for which you are applying?







Have you ever been bonded?

Have you ever been refused a bond?

In three sentences please describe why you would be a good employee.

Why do you want to work at Mid American Credit Union?

What assets would you bring to Mid American Credit Union?







List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. PLEASE GIVE MONTH AND YEAR FOR DATES OF EMPLOYMENT.

Date of Employment:
Pay:

Date of Employment:
Pay:

Date of Employment:
Pay:

Date of Employment:
Pay:







Have you worked under any other name(s)?

Are you presently employed?

If yes, may we contact your present employer?

Have you ever been fired from a job or asked to resign?

If yes, please explain:

Give three references, that are not relatives or former employers.

Name Address Phone






Mid American Credit Union is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program.

Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as a veteran or minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.

Please complete the information requested below. Thank you for your cooperation.

Please check all that apply (See below for definitions)

Race or Ethnic Identity










Gender



**Veteran Status



How did you hear of our opening?


EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES

Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino)
A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above five races.






PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize and agree to cooperate in a thorough investigation of all statements made herein and other matters relating to my background and qualifications. I understand that any investigation conducted may include a request for employment and educational history, credit reports, consumer reports, investigative consumer reports, driving record, bondability, and criminal history. I authorize any person, school, current and former employer, consumer reporting agency, and any other organization or agency to provide information relevant to such investigation and I hereby release all persons and corporations requesting or supplying information pursuant to such investigation from all liability or responsibility to me for doing so. I understand that I have the right to make a written request within a reasonable period of time for complete disclosure of the nature and scope of any investigation. I further authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the job for which I am being considered or any future job in the event that I am hired.

I understand I may be to successfully pass a drug-screening examination. I hereby consent to a pre-and/or post-employment drug screen as a condition of being hired or of my continued employment, if .

I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.


Mid American Credit Union

FAIR CREDIT REPORTING ACT

DISCLOSURE

Mid American Credit Union, when evaluating your application for employment, when deciding whether to offer you employment, when deciding whether to promote you, reassign you, or to continue your employment (if you are hired), and when making other employment-related decisions directly affecting you, may wish to obtain and use a "consumer report" about you, from a "consumer reporting agency." These terms are defined in the Fair Credit Reporting Act, 15 U.S.C.S. 1681 et seq. ("FCRA") which applies to you. As an applicant for employment or employee of our company, you are a "consumer" with rights under the FCRA.

"Consumer reporting agency" means a person or business which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing "consumer reports" to others.

"Consumer report" means any written, oral or other communication of any information by a consumer reporting agency bearing on a consumer's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected for the purpose of serving as a factor in establishing the consumer's eligibility for, among other things, employment purposes.

If we obtain a consumer report about you, and if we intend to make an employment-related decision that adversely affects you based in whole or in part on the consumer report, you will be provided with a copy of the consumer report before the decision is made final by our Company. Any decision regarding your employment will be made by us and not by the consumer reporting agency. You are also free to contact the Federal Trade Commission about your rights under the FCRA, as a "consumer," with regard to consumer reports and consumer reporting agencies.

AUTHORIZATION FOR RELEASE OF INFORMATION

I hereby authorize Mid American Credit Union through their agent to request and receive any and all background information about or concerning me, including but limited to my Criminal History, Driving Record, Employment History, Military Background, Bonding History, Civil Listings, Educational Background, Professional License from any Individual, Corporation, Law Enforcement Agency, other entities including my Present and Past Employers, and a Credit History including a consumer report under the Fair Credit Reporting Act, 15 U.S.C. 1681.

I also authorize the release all information regarding my services, character, conduct, accidents and safety performance. This also authorizes the release of all drug and alcohol testing and results while in other employ in accordance with Federal Motor Carrier Safety Regulations part 382.413. Former employers are released and held harmless of any liability from release of said information.

I further release and discharge Mid American Credit Union and their agent, and all their Subsidiaries, Related Corporations, Affiliates, Officers, Employees, Contract Personnel, or Associates, from any and all claims and liability arising out of any request for information or records pursuant to this authorization, procurement of an investigative consumer report and understand that it may contain information about my character, general reputation, personal characteristics, and mode of living, whichever is applicable. I acknowledge that I have voluntarily provided the above information for employment purposes, and have carefully read and understand what I am signing. Mid American Credit Union may use information contained in a consumer report in making employment decisions regarding hiring, promotion, retention or transfer. If any adverse employment decision is based in whole or in part due to information obtained through a consumer report, Mid American Credit Union will provide you with the name, address and telephone number of the consumer reporting agency that furnished the consumer report as well as a copy of the report that was obtained.

I have read, understand, and by my signature consent to these statements.


(Only .doc, .docx, .pdf, .txt or .rtf files please)





Mid American Credit Union8404 West Kellogg DriveWichita, KS 67209316.722.3921Fax 316.722.0920