Application for Employment

Why are you being asked to complete this form?

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor's office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp

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:

• Autism
• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
• Blind or low vision
• Cancer
• Cardiovascular or heart disease
• Celiac disease
• Cerebral palsy
• Deaf or hard of hearing
• Depression or anxiety
• Diabetes
• Epilepsy
• Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
• Intellectual disability
• Missing limbs or partially missing limbs
• Nervous system condition, for example, migraine headaches, Parkinson's disease, or Multiple sclerosis (MS)
• Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression

Reasonable Accommodation Notice

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.

Farmers Bank Applicant Statement

I certify that all information I have provided in order to apply and secure work with The Farmers Bank is true, complete and correct.

I authorize, without reservation, The Farmers 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 waive any and all rights and claims I may have regarding The Farmers Bank, its agents, 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 such information about me.

I understand that The Farmers Bank 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 and federal law.

I understand that this application will remain current for only 30 days. At the conclusion of that time, if I have not heard from The Farmers Bank and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

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 Farmers Bank reserves the 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 Farmers Bank is authorized to make any assurances to the contrary that that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by The Farmers Bank 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 required me to complete an I-9 Form in this regard.

The Farmers Bank will ensure that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with The Famers Bank affiliated(s) and third parties engaged by The Farmers Bank to perform services for The Farmers Bank. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by The Farmers Bank.

The Farmers Bank does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for on the basis of his or her race, creed, color, sex (including pregnancy), national origin, disability, age, genetic information, religion, or any other protected status under applicable federal, state, or local law.

I understand that any information provided by me that is found to be false, misrepresented in any respect, or incomplete, will be sufficient cause to eliminate me from further consideration for employment or may result in my discharge from The Farmers Bank service, whenever it is discovered.