Employment Application – Russell Country Federal Credit Union

Personal Information

Last Name *

First Name *

M.I. *

Relationship Name you

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email Address *

Social Security Number *

Referred By:

Are you a citizen of the U.S.? *

Have you ever worked for RCFCU? *

Have you ever been convicted of a felony? *

Employment Desired

Position *

Date Available *

Salary Desired *

Are you employed now? *

Have you ever applied with this company before? *

Education

High School Name *

High School Location *

College/University Name *

College/University Location *

Other Name *

Other Location *

Other Information

Special Training *

Activities (Civic, Athletic, etc.) *

Exclude organizations, the name or character of which indicates the race, creed, sex, marital status, age, color, or national origin of its members.

Former Employers

List the last three employers, starting with most recent

Employer Name *

Employer Address *

From Date *

To Date *

Position *

Salary *

Reason for Leaving *

Employer Name *

Employer Address *

From Date *

To Date *

Position *

Salary *

Reason for Leaving *

Employer Name *

Employer Address *

From Date *

To Date *

Position *

Salary *

Reason for Leaving *

References

Please list three professional references

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

I authorize investigation of all statements contained is this application. I understand that
misrepresentation or omission of facts called for is cause for dismissal. Further, I understand
and agree that my employment is for no definite period and may, at the discretion of the
employer, be terminated at any time without any previous notice.

Signed *

Type your full name