Our Legacy

Application for Employment

Legacy Bank is an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis including race, color, (Good for 60 days from signature date) age, sex, religion, disability, national origin, or marital status.

First Name Middle Initial
Last Name Suffix
Home Phone Number
Mobile Phone Number
Email

Present Address

Address
City
State
Zip

Permanent Address

Address
City
State
Zip

About the Position You're Applying For

Position you're applying for:
Referred By
Employment Desired Full Time Part Time
Start Date
Salary Desired
Are you employed now? Yes No
May we inquire of your present employer? Yes No
Have you applied to this company before? Yes No
Where
When

Education

Education Name and location of school Last year completed Did you graduate? Subject Studied & Degree(s) received
Grammar School
High School
College
Technical School

General

Subjects of special study or research work
Job related skills (typing, ten key, etc.)

Former Employers

List below your last (4) employers, starting with the last one first.

Start Date / /
End Date / /
Name & Address of Employer
Salary (Upon Leaving)
Position
Reason For Leaving
Start Date / /
End Date / /
Name & Address of Employer
Salary (Upon Leaving)
Position
Reason For Leaving
Start Date / /
End Date / /
Name & Address of Employer
Salary (Upon Leaving)
Position
Reason For Leaving
Start Date / /
End Date / /
Name & Address of Employer
Salary (Upon Leaving)
Position
Reason For Leaving

References

List below three (3) persons, not related to you, whom you have known at least one year.

Name
Address
Position
Years Known
Phone Number
Name
Address
Position
Years Known
Phone Number
Name
Address
Position
Years Known
Phone Number

Are you prevented from lawfully becoming employed in this country because of your visa or immigration status? Proof of citizenship or immigration status will be required upon employment.
Yes No

Yes No

While the existence of a record of conviction for criminal activity is not considered an automatic bar to employment, Legacy Bank as an FDIC-insured institution, may not employ any person who has been convicted of any criminal offense involving dishonesty or breach of trust, or has agreed to enter into pretrial diversion or similar program in connection with the prosecution for such offense except with the prior written consent of the FDIC.

Authorization

By submitting this form either electronically or by paper copy to Legacy Bank Human Resources, I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I agree to take any requested skills test given by Legacy Bank as part of the application process.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date or payment of my wages and salary, be terminated any time without cause and without prior notification.

Yes No

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