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State Employees’ Credit Union Application for Employment

We appreciate your interest in our organization. Please complete the application as fully as possible. Applicants are considered for available positions without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, genetic information, veteran status, disability or other classification protected by law. To be considered as an applicant, you must designate the particular available position for which you are seeking employment.

Position applied for: Date of application:

Applicant source: • 1 = Walk in • 3 = Friend • 5 = Advertisement • 7 = School/College • 9 = Other–Explain (select one)

• 2 = Job Service • 4 = Relative • 6 = Employment Agency • 8 = Job Posting

Personal Data

Last Name: First Name: Middle Initial:

Address: City: State: Zip:

Telephone Number: )

If employed and under 18, can you furnish a work permit?

Have you filed an application here before?

Have you ever been employed here before? If yes, give date:

Have you ever been bonded?

Have you ever refused bond?

Are you legally eligible to work in the United States? (SECU will require proof of citizenship or immigration status upon employment. SECU does not participate in the H1B or TN Visa programs.)

Do you have any relatives employed with the State Employees’ Credit Union? If yes, please list them and their relationship to you:

Your Job Requirements

Salary desired: When could you be available to begin work?

Are you willing to relocate anywhere in the state?

Can you travel if a job requires it?

Select desired type of employment:

The following conditions may be required at some point in a job assignment. If required, would you be willing to work:

a. shift work? c. a work schedule other than Monday through Friday?

b. overtime work? d. a rotational work schedule? e. fluctuating hours?

Education High School Business/Technical School College Graduate School

School name and location

Years completed

Diploma/Degree Earned

Activities & Offices List professional, trade business or civic activities and offices held.

(You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, disability, or other protected status.)

Work Experience

List the last three positions you have held beginning with the most recent, or all the positions held in the last three years. If you do not have enough space, you may give more complete and detailed information on additional pages. Accuracy of dates and addresses is essential.

Present or Last Employer Description of Work

Address

Position Reason for Leaving

Dates of Employment From:

To:

Starting Salary Final Salary Supervisor’s Name and Title Telephone No.

Present or Last Employer Description of Work

Address

Position Reason for Leaving

Dates of Employment From:

To:

Starting Salary Final Salary Supervisor’s Name and Title Telephone No.

Present or Last Employer Description of Work

Address

Position Reason for Leaving

Dates of Employment From:

To:

Starting Salary Final Salary Supervisor’s Name and Title Telephone No.

Do you have any commitments to another employer or organization which might affect your employment with us? If yes, please explain:

References Give name, address and telephone number of three references who are not related to you and who are not previous employers.

1.

2.

3.

Applicant’s Certification and Agreement Please read carefully before signing. Signature must be handwritten.

The information that I have provided on this application is complete and accurate to the best of my knowledge and subject to validation by the Credit Union. I understand that any misleading or incorrect statement or omissions may render it void, and if I am employed, be cause for immediate dismissal at any time during my employment. I authorize all persons, schools, employers, and other organizations to provide the Credit Union with any relevant information that may be required to arrive at an employment decision. I hereby release these employers and individuals from all liability for any damage incurred in furnishing such information. In processing this employment application, I understand that State Employees’ Credit Union will request that an investigative or Credit Bureau report be prepared. This report will include a Criminal Record Report and may include information as to my character and general reputation. Each staff member must be approved and accepted for bonding by a surety company designated by the Credit Union in order to continue employment. In signing this application I authorize the Credit Union to supply my employment record in whole or in part, and in confidence to any prospective employer, government agency, or other party with a legal interest. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. I further agree to comply with all policies of State Employees’ Credit Union.

Signature of Applicant: Date:

SECU 441 (08/19)

PRE-OFFERVOLUNTARYSELF-IDENTIFICATION EEO / AFFIRMATIVE ACTION INFORMATION

SECU provides equal employment opportunity to all qualified persons regardless of race, color, religion, age, genetics, sex, sexual orientation, gender identity, national origin, disability, veteran status or other classification protected by law. This policy is applied to all employment actions including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training including apprenticeship.

State Employees’ Credit Union is required by law to document demographic information of applicants for affirmative action reporting. Completion of this form is voluntary, and participation or refusal of participation will not affect the hiring decision.

Please complete the following and submit with your application.

Last Name: First Name:

Date: Position Applied For:

GENDER Male Female Decline to Self-Identify

RACE/ETHNICITY Hispanic or Latino

If not Hispanic or Latino:

White

Black or African American

Native Hawaiian or Pacific Islander

Asian

American Indian or Alaska Native

Two or More Races

Decline to Self-Identify

VETERAN STATUS I identify as one or more of the classifications of protected veteran listed below I am not a protected veteran

Decline to Self-Identify

Signature: Signature must be handwritten.

*See next page for EEOC Race/Ethnic identification category definitions and protected veteran classifications*

August 26, 2019

EEOC/Race/EthnicIdentificationCategories

Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race

White – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American – A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander – A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.

Asian – 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 – 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 – All persons who identify with more than one of the above five races.

Protected Veteran Classifications

A “disabled veteran” is one of the following: · a veteran of the US 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.

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 US military, ground, naval or air service.

An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the US 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.

An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the US military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Protected veterans may have additional rights under USERRA – the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Dept of Labor’s Veterans Employment and Training Service (VETS) at 1-866-4-USA-DOL.

August 26, 2019

Voluntary Self-Identification of Disability Form CC-305 Page 1 of 1

OMB Control Number 1250-0005 Expires 05/31/2023

Name: Employee ID:

(if applicable)

Date:

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 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 you know if you 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 • Deaf or hard of hearing • Missing limbs or partially missing • Autoimmune disorder, for example, • Depression or anxiety limbs

lupus, fibromyalgia, rheumatoid • Diabetes • Nervous system condition for arthritis, or HIV/AIDS example, migraine headaches, • Epilepsy

• Blind or low vision Parkinson’s disease, or Multiple • Gastrointestinal disorders, for sclerosis (MS) • Cancer example, Crohn's Disease, or

• Psychiatric condition, for example, • Cardiovascular or heart disease irritable bowel syndrome bipolar disorder, schizophrenia,

• Celiac disease • Intellectual disability PTSD, or major depression • Cerebral palsy

Please check one of the boxes below:

☐ 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

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.

Notice of Reasonable Accommodation

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please contact us if you require a reasonable accommodation to apply for a job or to perform your job.

Examples of reasonable accommodation include make a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

~loyees' Credit Union AppHcati'on for Empl0Jmenl Addendum -

CONSUMER REPORT FOR EMPLOYMENT PURPOSES

I hereby authorize State Employees’ Credit Union to obtain a consumer report and a criminal records search from a consumer reporting agency for employment purposes only. If I am hired by the State Employees’ Credit Union, this authorization will be valid during my employment.

I also authorize FirstPoint to perform a criminal records search. I understand that FirstPoint does not guarantee the accuracy or timeliness of the information obtained from other sources and that FirstPoint will not be liable for any inaccuracy in the information obtained from other sources that are included in the INSIGHT report.

Signature of Applicant: Date:

FOR INTERNAL USE ONLY

Account Number:

Name (Please Print):

Current Address:

Social Security Number:

Birth Date:

SECU 709 (Revised 07/07/16)

State Em~,foyees' Credit Union 2 11-Ji . AgpHcaUon for Employmenl

Nationwide Mortgage Licensing System Disclosure

I agree to disclose if I have ever been registered with the Nationwide Mortgage Licensing System (NMLS) and will provide my NMLS ID. I agree to disclose any administrative, criminal or civil findings made by any government jurisdiction once I have been offered employment. If I am hired by the State Employees’ Credit Union, this authorization will be valid during my employment.

Signature of Applicant: Date:

07/07/16