Kalamazoo County State Bank Employment Application

The Bank is an equal opportunity employer and does not discriminate on the basis of age, sex, race, religion, color, national origin, disability, marital status, genetic information, veteran status, height, weight or other legally protected status.

If you have a disability that impairs your ability to be considered, interviewed or tested for a position, please let us know what accommodations you may require.

Please complete the entire application and sign the AUTHORIZATION AND UNDERSTANDING at the end of the application. This application will not be considered otherwise. If there is not enough space on this form to answer a question fully or to supply complete information, please attach additional pages.

Date Name Phone Number Email Present Address City State Zip Code Please supply other names under which records may be kept Position applied for

Schedule Full Time Part Time

If part time, please specify days and hours Starting salary requested How were you referred to the Bank?

Have you ever applied here before or been employed here before? Yes No

If yes, please specify

Are any of your friends or relatives employed at the Bank? Yes No

If yes, please specify

Are you 18 years old or older? Yes No

If not, do you have proof of eligibility to work? Yes No

Are you legally authorized to work in the United States? Yes No

Are you presently attending school or do you plan on furthering your education? Yes No

If so, please specify course and time commitment What experiences, skills, or qualifications do you feel especially would qualify you for work with the Bank?

Have you ever been bonded? Yes No

If yes, on what jobs?

Have you ever lost your bonded status? Yes No

If yes, please supply details

Have you ever been convicted of a crime (including guilty pleas and pleas of no contest), excluding routine traffic offenses, but including alcohol related driving offenses? Yes No

If yes, please describe (A "yes" response does not automatically disqualify a job applicant from further consideration.)

Are there any felony charges pending against you currently? Yes No

If yes, please describe (A "yes" response does not automatically disqualify a job applicant from further consideration.)

Do you hold any professional licenses or certifications? Yes No

If yes, please list and describe

Have you ever had a professional license or certification revoked or suspended? Yes No

If yes, please list and describe

Are you currently under investigation by any agency or department concerning any licensure or certification matter? Yes No

If yes, please describe

Are you currently employed? Yes No

May we contact your current employer? Yes No

Note to applicants: DO NOT ANSWER THIS QUESTION UNTIL THE JOB DESCRIPTION OF THE JOB FOR WHICH YOU ARE APPLYING HAS BEEN REVIEWED (AT THE TIME OF THE INTERVIEW):

Are you able to perform the tasks involved in the job for which you have applied, with or without accommodation? Yes No

Education

Type	Name and Address	Did you graduate?	Course of Study/Degree Conferred
High School	Name and Address	Did you graduate?	Course of Study/Degree Conferred
College	Name and Address	Did you graduate?	Course of Study/Degree Conferred
Other	Name and Address	Did you graduate?	Course of Study/Degree Conferred

Employment History

Start with the most recent; include your entire employment history and military service – attach additional pages if necessary:

If no work history, write 'None'

Employer

Employer Name, Address and Phone Number Dates of Employment: From To Position, duties and Supervisor Reason for leaving

Personal References (not former employers or relatives)

Reference

Name and Occupation Address Phone Number

Authorization and Understanding

I represent that the answers and information given by me in this application are true and complete. I understand that any incomplete, misleading or false statements in this application or in an interview can result in immediate disqualification or termination, if hired.

I authorize the Bank to verify the information I have provided and to make any investigation of my background deemed necessary, both at the time of application and later during my employment, if I am hired. I understand that the types of investigations which the Bank may perform include reference checks (personal, employment, educational, etc.), criminal record reports and so forth. I understand that I may have to provide further information to assist in these investigations and I may be fingerprinted. I also authorize third parties (such as former employers, law enforcement organizations, financial institutions, educational institutions, etc.) contacted by the Bank to furnish any information relevant to my application for employment, excluding health and medical history or other information prohibited by law, and I further release all persons and organizations from any and all liability for any and all damages whatsoever for releasing such information. I also waive all written notice from all prior employers related to providing such information.

I have no objection to signing an employment agreement on confidential information. I consent to all legally permissible medical examinations and drug and alcohol testing required by the Bank, both during the selection process and throughout employment, if I am later hired.

I understand and agree that employment with the Bank is at will and that either I or the Bank can terminate my employment and compensation, with or without cause, and with or without notice, at any time. I acknowledge that no representations, either oral or written, have been made to me to the contrary and that any pre-existing understandings which contradict an at will status of employment are canceled. Further, I understand that only the Board of Directors has any authority to enter into any agreement for employment for any fixed period of time, or to make any agreement contrary to the foregoing and that any such agreement must be in writing and signed by the Board of Directors.

In consideration of my employment, I agree to conform to the rules and policies of the Bank. Also, I agree not to begin any action or suit relating to employment with the Bank more than six (6) months after the date of the termination of such employment and I waive any statute of limitations to the contrary. However, I agree that any shorter statute of limitations remain in effect. This application for employment shall be considered active for a period of time not to exceed 60 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

By clicking the “I accept” box below, I certify that I have read and understood the above paragraphs.

Yes, I accept Type the numbers you see above: