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EMPLOYMENT APPLICATION

NOTIFICATION TO ALL APPLICANTS

It is the policy of West Bend Savings Bank to provide employment , compensation and other employment benefits based on qualifications without regard to race, color. religion, national origin, age, sex, veteran status or handicap or any other basis prohibited by federal or state law.

Receipt of this application by West Bend Savings Bank does not guarantee a job interview or an offer of employment. Employment with West Bend Savings Bank may be contingent upon one or more personal interviews, an investigation of past work history and references, and the satisfactory completion of a criminal background check.

If an employment relationship is established, employment is at will and you may terminate your employment at any time and West Bend Savings Bank reserves the same right.

As an Equal Opportunity Employer, West Bend Savings Bank intends to comply with all federal and state laws, and the information requested on this application will not be used for any purpose prohibited by law. 

 
Employment Application:
1.
*

Your Full Name (please include middle initial)
 
2.
Previous or maiden name
 
3.
* Your Address
 
4.
* Home Phone
 
5.
Business Phone
 
6.
Previous address (if less than 2 years at present address)
 
7.
E-mail Address
 
8.
* Are you under 18 years of age?
 
yes   no
9.
Who referred you to West Bend Savings Bank?
 
10.
* Position you are applying for
 
11.
Hours Available to Work
 
12.
* In what branch offices are you willing to work? (1 required)
 
Germantown   Kewaskum
Slinger Village Square   Slinger Seven Hills
Jackson   W. Washington
West Bend Downtown   Random Lake
West Bend North   West Bend South
West Bend East   Allenton
Hartford East   Hartford West
Lake Five   Richfield
Beaver Dam North   Beaver Dam South
13.
Date available to begin work
 
14.
* Employment Preference
 
Full Time   Part Time
Peak Time
15.
If applying for temporary employment check here (0 required)
 
temp employment
16.
Rate of Pay Desired
 
17.
* Have you ever been convicted of a felony, misdemeanor, or do you have any charges pending against you?
 
no   yes
18.
If yes, please explain.
 
19.
*

* A conviction or pending charge will not be an automatic bar to employment and will be considered only as it relates to the job in question.

Have you ever paid a civil forfeiture or fine for a non-traffic related offense?
 
yes   no
20.
** Payment of a civil forfeiture or fine will not be an automatic bar to employment and will be considered only as it relates to the job in question.


Please list any special characteristics, skills, attitudes or achievements which you feel would qualify you for a position with West Bend Savings bank. Feel free to list any participation in community/civis activities, special achievements, awards, hobbies, etc.
 
21.
* Educational History
Please include name of high school- if you graduated or attained a GED. Name of college or tech schools and major courses of study and degrees attained
 
22.

Please list employment history starting with the most recent employer.

Name and address of Employer #1 (most recent)
 
23.
Dates of Employment
 
24.
Position or Title
 
25.
Job Responsibilities
 
26.
Reason for leaving
 
27.
Name and Phone # of Supervisor
 
28.
Supervisor e-mail address
 
29.
* May we contact this employer?
 
yes   no
30.
Name and address of next most recent employer (#2)
 
31.
Dates of Employment
 
32.
Position or Title
 
33.
Job Responsibilities
 
34.
Reason for leaving
 
35.
Name and phone # of Supervisor
 
36.
Supervisor e-mail address
 
37.
May we contact this employer?
 
yes   no
38.
Name and address of next most recent employer (#3)
 
39.
Dates of Employment
 
40.
Position or Title
 
41.
Job responsibilities
 
42.
Reason for leaving
 
43.
Name and phone # of Supervisor
 
44.
Supervisor e-mail address
 
45.
May we contact this employer?
 
yes   no
46.

To list more previous employers- please -email as an attachment to mary.kurer@wbsavings.com
in subject line please put name and postition applying for.
 
47.

Please list 3 work references including name and phone number.

Referral Name and Address (1)
 
48.

Referral Name and Address (2)
 
49.

Referral Name and Address (3)
 
50.
*

I authorize investigation of all statements contained in this application or made by me during my interview. I understand that misrepresentation or omission of facts called for may cause for rejection or subsequent dismissal if hired. I also authorize any former employer, person, firm, corporation or government agency to disclose to West Bend Savings Bank any information they may have regarding me. I understand that the employment information may include, but is not necessarily limited to, performance evaluations and reports, job descriptions, disciplinary reports, letters of reprimand, and opinions regarding my suitability for employment possessed by it. I agree that West Bend Savings Bank shall not be held liable if I am denied employment or terminated following employment if it is verified that I submitted false statements or omitted substantive information.

I release West Bend Savings Bank, as well as any providers of information, from any liability and for any damage which may result from the furnishing of information provided during the background investigation of my application and interview except from the malicious and willful disclosure of derogatory facts concerning my employment made for the express purpose of preventing me from obtaining employment which the officer, employee or agent disclosing the facts knows are untrue.
 
I authorize   I decline- do not submit my application
  
 
       
Headquarters at: 201 South Fifth Avenue    West Bend, WI 53095    (262) 334-5563

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