APPLICATION FOR EMPLOYMENT

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Select the position you are applying for
Position you are applying for*
Would you like to apply for any additional open positions?
- Yes
Which additional positions would you like to apply for?
Please upload your Resume in pdf format
Accepted file types: pdf, doc, rtf, txt, odf, docx, Max. file size: 64 MB.
Personal Information 1 of 2
Name*
First Middle Last
Address*
Street Address City State ZIP Code
Phone (primary)*
Phone (secondary)
Email*
Date of application*
MM slash DD slash YYYY
Referral Source*
Please check the appropriate category and list the source below.
- Walk-in
- Employee
- Advertisement
- Company’s Website
- Other Internet
- School
- Job Fair
- Staffing Agency
- Government Employment Agency
- Other
Walk-in: Referral source*
Employee: Referral source*
Advertisement: Referral source*
Company's Website: Referral source*
Other Internet: Referral source*
School: Referral source*
Job Fair: Referral source*
Staffing Agency: Referral source*
Government Employment Agency: Referral source*
Other: Referral source*

Personal Information 2 of 2
Is there a best time to call?
- Any time will work
- Yes, there is a specific time that will work best
Best time to call (optional)

: Hours

Minutes

AM/PM
Which number should we call (optional)
- Primary number
- Secondary number
May we contact you at work?*
- Yes
- No
Best work number to call
Best time to call you at work

: Hours

Minutes

AM/PM
If you are under 18 and it is required, can you furnish a work permit?*
- N/A
- Yes
- No
Please Explain
Have you submitted an application here before?*
- Yes
- No
Please give date(s) and position(s):
Have you ever been employed here before?*
- Yes
- No
Past start date*
MM slash DD slash YYYY
Past end date*
MM slash DD slash YYYY
Is this application a request for reemployment following an extended military leave of absence for this company?*
- Yes
- No
Are you lawfully authorized to work in the United States?*
- Yes
- No
Date available for work*
MM slash DD slash YYYY
What is your desired salary range or hourly rate of pay?
Salary
Per
Type of employment desired*
- Full-Time
- Part-Time
- Seasonal
- Temporary
Will you travel if job requires it?*
- Yes
- No
Will you work overtime if required?*
- Yes
- No
Please explain*
Have you entered into an agreement with any former employer or other party (such as a non-competition agreement) that might, in any way, restrict your ability to work for our company?*
- Yes
- No
Please explain*
Are you related to anyone at this bank?*
- Yes
- No
Who are you related to?*

Employment History 1 of 2
If you do not have a job history
- Skip this section
Current Employer / Most Recent Employer
Are you currently employed here?*
- Yes
- No
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Compensation
$
Commission / Bonus / Other Compensation $
Phone*
Address*
Street Address City State ZIP Code
Starting job title / Final job title
Immediate supervisor and title (form most recent position held)*
May we contact for reference?*
- Yes
- No
- Later
Email
Why did you leave?*
Summarize the type of work performed and job responsibilities*
What did you like most about your position?*
What were the things you liked least about the position?*
Second past employer*
- Yes
- None
Employer
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Compensation
$
Commission / Bonus / Other Compensation $
Phone*
Address*
Street Address City State ZIP Code
Starting job title / Final job title
Immediate supervisor and title (form most recent position held)*
May we contact for reference?*
- Yes
- No
- Later
Email
Why did you leave?*
Summarize the type of work performed and job responsibilities*
What did you like most about your position?*
What were the things you liked least about the position?*
Third past employer*
- Yes
- None
Employer
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Compensation
$
Commission / Bonus / Other Compensation $
Phone*
Address*
Street Address City State ZIP Code
Starting job title / Final job title
Immediate supervisor and title (form most recent position held)*
May we contact for reference?*
- Yes
- No
- Later
Email
Why did you leave?*
Summarize the type of work performed and job responsibilities*
What did you like most about your position?*
What were the things you liked least about the position?*
Fourth past employer*
- Yes
- None
Employer
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Compensation
$
Commission / Bonus / Other Compensation $
Phone*
Address*
Street Address City State ZIP Code
Starting job title / Final job title
Immediate supervisor and title (form most recent position held)*
May we contact for reference?*
- Yes
- No
- Later
Email
Why did you leave?*
Summarize the type of work performed and job responsibilities*
What did you like most about your position?*
What were the things you liked least about the position?*

Employment History 2 of 2
Explain any gaps in your employment, other than those due to personal illness, injury or disability.
If not addressed on previous page, have you ever been fired or asked to resign from a job?
- Yes
- No
Please explain*

Skills and Qualifications
Summarize any special training, skills, licenses and / or certificates that may assist you in performing the position for which you are applying.
Skills
- Typing
- Word
- Excel
- Email
- Other (1)
- Other (2)
- Other (3)
- Other (4)
Years Typing
Years using Word
Years using Excel
Years using Email
Skill Name: Other (1)
Years: Other (1)
Skill Name: Other (2)
Years: Other (2)
Skill Name: Other (3)
Years: Other (3)
Skill Name: Other (4)
Years: Other (4)
Please expand on any specifics concerning your computer skills.

Educational Background
School
City
Year completed
GPA Class Rank
Major / Minor
Type of Degree*
- Diploma
- GED
- Degree
- Certification
- Other
Please specify for the following: Degree, Certification, Other
Second Additional Education/Degree
- Yes
- No
School
City
Year completed
GPA Class Rank
Major / Minor
Type of Degree*
- Diploma
- GED
- Degree
- Certification
- Other
Please specify for the following: Degree, Certification, Other
Third Additional Education/Degree
- Yes
- No
School
City
Year completed
GPA Class Rank
Major / Minor
Type of Degree*
- Diploma
- GED
- Degree
- Certification
- Other
Please specify for the following: Degree, Certification, Other
Fourth Additional Education/Degree
- Yes
- No
School
City
Year completed
GPA Class Rank
Major / Minor
Type of Degree*
- Diploma
- GED
- Degree
- Certification
- Other
Please specify for the following: Degree, Certification, Other

References
List names and telephone numbers of three business / work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Name*
First Last
Title*
Relationship to you*
Phone*
Email
# of years known*
Reference #2
Name*
First Last
Title*
Relationship to you*
Phone*
Email
# of years known*
Reference #3
Name*
First Last
Title*
Relationship to you*
Phone*
Email
# of years known*

Related Information
To what job-related organizations (professional, trade, etc.) do you belong?
When answering the following questions, please exclude any information that would reveal race, creed, color, sex (including pregnancy), religion, national origin, disability, age, genetic information, or any other similarly protected status.
Organization
Offices Held
Organization
Offices Held
Organization
Offices Held
Organization
Offices Held
List special accomplishments, publications, awards, etc.
Please Explain
Is there any other job-related information you want us to know about you?

VOLUNTARY SELF-IDENTIFICATION FORM AND VETERAN STATUS DATA

PLEASE NOTE: Completion of this form is voluntary

The Equal Employment Opportunity Commission (EEOC) requires all private employers with 100 or more employees, as well as federal contractors and first-tier subcontractors with 50 or more employees AND contracts of at least $50,000, to complete an EEO-1 report each year. Covered employers must invite employees to self-identify gender and race for this report.
Completion of this form is voluntary, and your choice to complete it will not affect your opportunity for employment or the terms and conditions of your employment. Your responses also will not affect your opportunity for or the terms/conditions of employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records; only the human resources department will have access to this form. If you choose not to self-identify at this time, the federal government requires The Farmers Bank to determine this information by visual survey and/or other available information.
Gender
- Male
- Female
Please select one of the following Equal Employment Opportunity Identification Groups
- 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.
- 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 examples, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
- Native Hawaiian / Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
- Black / African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.
- Native American / Alaskan 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 races of White, Black or African American, Native Hawaiian or Other Pacific Islander, Asian, or American Indian or Alaska Native
Post-Offer Invitation to Self-Identify as a Veteran (VEVRAA)
The Farmers Bank is a government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act (VEVRAA) of 1974, The Farmers Bank is required to submit a report to the U.S. Department of Labor each year identifying the number of protected veterans who were newly hired, as well as the number of protected veterans who were employed. If you believe you belong to any of the categories of protected veterans listed below, please indicate so by checking the appropriate box.
Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are consistent with the VEVRAA, as amended.
Veteran Status Information*
- Disabled Veteran
- Recently Separated Veteran
- Active Wartime or Campaign Badge Veteran
- Armed Forces Service Medal Veteran
- I am a protected veteran, but I choose not to self-identify the classifications to which I belong.
- I am NOT a protected veteran.
Veteran Status Information
Disabled Veteran: A “disabled veteran” is one of the following: A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or A person who was discharged or released from active duty because of a service-connected disability.
Recently Separated Veteran: A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.
Active Wartime or Campaign Badge Veteran: An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces Service Medal Veteran: An “Armed Forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a U.S. military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Voluntary Self-Identification of Disability
Why are you being asked to complete this form?

The Farmers Bank is 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. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had a one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
- Alcohol or other substance use disorder (not currently using drugs illegally)
- Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
- Blind or low vision
- Cancer (past or present)
- Cardiovascular or heart disease
- Celiac disease
- Cerebral palsy
- Deaf or serious difficulty hearing
- Diabetes
- Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
- Epilepsy or other seizure disorder
- Gastrointestinal disorders, for example, Crohn’s Disease, irritable bowel syndrome
- Intellectual or developmental disability
- Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
- Missing limbs or partially missing limbs
- Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
- Nervous system condition, for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)
- Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
- Partial or complete paralysis (any cause)
- Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
- Short stature (dwarfism)
- Traumatic brain injury
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.
Voluntary Self-Identification of Disability*
- Yes, I Have A Disability, Or Have A History/Record Of Having A Disability
- No, I Don’t Have A Disability, Or A History/Record Of Having A Disability
- I Don’t Wish To Answer

The Farmers Bank Applicant Statement
Please read carefully before agreeing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for The Farmers Bank to hire me. If I am hired, I understand that either The Farmers Bank or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of The Farmers Bank has the authority to make any assurance to the contrary.

I attest with my agreement below that I have given to The Farmers Bank true and complete information on this application. No requested information has been concealed. I authorize The Farmers Bank to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
Applicant Statement Agreement*
- Yes
- No

NOTICE: The Farmers Bank is not responsible for and has no control over the subject matter, content, information, or graphics of the websites that have links here. The portal and news features are being provided by an outside source – The bank is not responsible for the content. Please contact us with any concerns or comments. Information is subject to change without notice.

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APPLICATION FOR EMPLOYMENT

Step 1 of 11

Select the position you are applying for

Personal Information 1 of 2

Personal Information 2 of 2

Employment History 1 of 2

Employment History 2 of 2

Skills and Qualifications

Educational Background

References

Reference #2

Reference #3

Related Information

Voluntary Self-Identification of Disability

The Farmers Bank Applicant Statement