Employment Application

Thank you for your interest in Farmers & Merchants Bank. Please complete all necessary information and submit. This application will be kept on file for 90 days. In compliance with federal, state, and local equal employment opportunity laws, qualified applicants are considered for all positions with Farmers & Merchants Bank without regard to race, color, religion, creed, sex, national origin, age, marital status, physical or mental disability. Federal law obligates us to provide reasonable accommodation to the known disabilities of applicants and employees, unless to do so would pose an undue hardship. Please let us know if you need an accommodation to complete the application process or to perform any essential elements of the positions sought.

Personal Information

Name

First Last

Day Phone

Evening Phone

Cell Phone

Email

Best Way to Contact Me

Address

Street Address Address Line 2 City State ZIP Code

Employment Desired

Position applying for

Bank location applying for

Date available for work

Would you accept full-time work?

Yes
No

Would you accept part-time work?

Yes
No

Any restrictions on hours, weekends, overtime or travel? If yes, explain:

Please list any salary requirements you have:

Have you been employed at this company before?

Yes
No

What Position?

What dates?

Can you, after employment, submit verification of your legal right to work in the United States? 

Yes
No

Are you 16 years of age or older?

Yes
No

If no, can you furnish a work permit?

Yes
No

Have you ever been convicted of a felony?

Yes
No

If yes, please explain:

Note: Convictions will not automatically disqualify job candidates. The seriousness of the crime and date of convictions will be considered.

Have you ever been bonded?

Yes
No

If yes, please explain:

Is there anything that would prevent you from performing the essential functions of the position for which you are applying, with or without reasonable accommodation?

Yes
No

If yes, please explain:

Referral Source

Please select all that apply:

Advertising
Employee:
Walk-in
Bank's Website
Other:

Employee:

Other:

Education

High School Name:

High School Location:

Did you graduate?

Yes
No

If yes, what degree or diploma?

College Name:

College Location:

Did you graduate?

Yes
No

If yes, what degree or diploma?

Other Name:

Other Location:

Did you graduate?

Yes
No

If yes, what degree or diploma?

Are you attending school now?

Yes
No

If yes, where?

If yes, what course of study?

Do you plan further educational study?

Yes
No

If yes, when and what field?

Professional References

Please provide three references (other than relatives or personal friends) that have knowledge of your skills and abilities for the position you are applying for.

Reference #1

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Occupation:

How many years have you known this person?

Reference #2

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Occupation:

How many years have you known this person?

Reference #3

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Occupation:

How many years have you known this person?

Previous Employment

Please provide details of previous employment by starting with your present or most recent job. Supply all requested information. A résumé cannot be substituted.

Company #1

Company

Position

Address

Street Address Address Line 2 City State ZIP Code

Phone

Hours Scheduled to Work Per Week:

Dates of Employment:

Start Date:

End Date:

Supervisor's Name:

May We Contact Them?

Yes
No

Primary Responsibilities and Duties:

Reason for Leaving:

Company #2

Company

Position

Address

Street Address Address Line 2 City State ZIP Code

Phone

Hours Scheduled to Work Per Week:

Dates of Employment:

Start Date:

End Date:

Supervisor's Name:

May We Contact Them?

Yes
No

Primary Responsibilities and Duties:

Reason for Leaving:

Company #3

Company

Position

Address

Street Address Address Line 2 City State ZIP Code

Phone

Hours Scheduled to Work Per Week:

Dates of Employment:

Start Date:

End Date:

Supervisor's Name:

May We Contact Them?

Yes
No

Primary Responsibilities and Duties:

Reason for Leaving:

Company #4

Company

Position

Address

Street Address Address Line 2 City State ZIP Code

Phone

Hours Scheduled to Work Per Week:

Dates of Employment:

Start Date:

End Date:

Supervisor's Name:

May We Contact Them?

Yes
No

Primary Responsibilities and Duties:

Reason for Leaving:

Please explain any gap in employment greater than two months:

Have you ever been discharged, suspended, terminated, or resigned with no notice?

Yes
No

If yes, please explain:

Skills and Abilities

Please select all that apply:

Ten-Key Calculator
Office Machines (copier, scanner, fax, etc.)
Switchboard
Computer Skills

Please list computer programs you have experience with:

Please include any other information you think would be helpful to us in considering you for employment, such as professional organizations, community involvement, activities, accomplishments, etc.:

Please read and respond to the following statement:

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE. I UNDERSTAND THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR HOW DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before submitting. The application will be given every consideration, but its receipt does not imply that the applicant will be employed. I authorize the investigation of all statements and information contained in this application.

* I acknowledge that I have read and understood the above statement and hereby grant permission to confirm the information supplied on this application by me.

Yes

The following items may be disclosed by a current or former employer regarding the applicant’s employment history:

Dates and duration of employment;
Final pay rate and wage history;
Job description and duties;
The most recent performance evaluation provided to the employee during his or her  employment;
Attendance information;
Drug and alcohol testing results within one year prior to the date of the reference request;
Threats of violence, harassing acts, or threatening behavior related to the workplace;
Whether the employee was voluntarily or involuntarily separated from employment, and the  reasons for the separation; and
Whether the employee is eligible for rehire.

The above information does not require Farmers & Merchants Bank to request employment history on an applicant nor does it require any current or former employer to disclose history. This consent is valid no longer than six months after the date the application is submitted.

*I hereby give consent to any and all prior employers of mine to provide information with regard to my employment with prior employers to Farmers & Merchants Bank.

Yes

Personal Information

Employment Desired

Referral Source

Education

Professional References

Previous Employment

Skills and Abilities

Please read and respond to the following statement:

The following items may be disclosed by a current or former employer regarding the applicant’s employment history:

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