San Francisco Federal Credit Union

PLEASE PRINT

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Position(s) applied for Date of application / /

Referral Source

Advertisement Employee Relative Government Employment Agency Walk-in Private Employment Agency Other
Name of source (if applicable)

Name
	LAST	FIRST	MIDDLE

Social Security#

Address


Street		City	State	Zip Code

Telephone # ( )
Mobile/Beeper/Other Phone # ( )
E-mail Address

If necessary, best time to call you at home is	AM PM
May we call you at work? If yes, work number and best time to call ( )	AM PM
If you are under 18 and it is required, can you furnish a work permit? If no, please explain	YES NO
Have you submitted an application here before? If yes, give date(s) and position(s)	YES NO
Have you ever been employed here before? If yes, give dates From / / To / /	YES NO
Are you legally eligible for employment in this country?	YES NO
Date available for work / / What is your desired salary range? $
Type of employment desired Full-time Part-Time Temporary Seasonal Educational Co-Op
Will you relocate if job requires it?	Yes No
Will you travel if job requires it?	Yes No
Are you able to meet the attendance requirements of the position?	Yes No
Will you work overtime if required? If no, please explain	Yes No
Have you ever been bonded?	Yes No
Have you ever pled "guilty" or "no contest" to, or been convicted to a crime? If yes, please provide date(s) and details	Yes No
ANSWERING "YES" TO THESE QUESTIONS DOES NOT CONSTITUTE A BAR TO EMPLOYMENT. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.
Driver's license number if driving is an essential job function State
AN EQUAL OPPORTUNITY EMPLOYER

Employment History

Provide the following information of your past and current employers, assignments or volunteer activities, starting with the most recent (use additional sheets if necessary). Explain any gaps in employment in comments section below.

EMPLOYER

ADDRESS

TELEPHONE
( )

DATES EMPLOYED

FROM
/

TO
/

SUMMARIZE THE TYPE OF WORK PERFORMED AND JOB RESPONSIBILITIES

STARTING JOB TITLE

HOURLY RATE/SALARY
STARTING

PER

FINAL JOB TITLE

IMMEDIATE SUPERVISOR AND TITLE

REASON FOR LEAVING
MAY WE CONTACT FOR REFERENCES? YES NO
LATER

HOURLY RATE/SALARY
FINAL

PER

EMPLOYER

ADDRESS

TELEPHONE
( )

DATES EMPLOYED

FROM
/

TO
/

SUMMARIZE THE TYPE OF WORK PERFORMED AND JOB RESPONSIBILITIES

STARTING JOB TITLE

HOURLY RATE/SALARY
STARTING

PER

FINAL JOB TITLE

IMMEDIATE SUPERVISOR AND TITLE

REASON FOR LEAVING

MAY WE CONTACT FOR REFERENCES? YES NO
LATER

HOURLY RATE/SALARY
FINAL

PER

EMPLOYER

ADDRESS

TELEPHONE
( )

DATES EMPLOYED

FROM
/

TO
/

SUMMARIZE THE TYPE OF WORK PERFORMED AND JOB RESPONSIBILITIES

STARTING JOB TITLE

HOURLY RATE/SALARY
STARTING

PER

FINAL JOB TITLE

IMMEDIATE SUPERVISOR AND TITLE

REASON FOR LEAVING
MAY WE CONTACT FOR REFERENCES? YES NO
LATER

HOURLY RATE/SALARY
FINAL

PER

EMPLOYER

ADDRESS

TELEPHONE
( )

DATES EMPLOYED

FROM
/

TO
/

SUMMARIZE THE TYPE OF WORK PERFORMED AND JOB RESPONSIBILITIES

STARTING JOB TITLE

HOURLY RATE/SALARY
STARTING

PER

FINAL JOB TITLE

IMMEDIATE SUPERVISOR AND TITLE

REASON FOR LEAVING

MAY WE CONTACT FOR
REFERENCES? YES NO
LATER

HOURLY RATE/SALARY
FINAL

PER

Comments INCLUDING EXPLANATION OF ANY GAPS IN EMPLOYMENT

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Educational Background (if job related)

A. List last three (3) schools attended, starting with most recent. B. List number of years completed. C. Indicate degree of diploma earned, if any. D. Grade Point Average or Class Rank. E. Major field of study. F. Minor field of study (if applicable)

A. SCHOOL	B. NUMBER OF YEARS COMPLETED	C. DEGREE DIPLOMA	D. GPA CLASS RANK

E. MAJOR	F. MINOR

A. SCHOOL	B. NUMBER OF YEARS COMPLETED	C. DEGREE DIPLOMA	D. GPA CLASS RANK

E. MAJOR	F. MINOR

A. SCHOOL	B. NUMBER OF YEARS COMPLETED	C. DEGREE DIPLOMA	D. GPA CLASS RANK

E. MAJOR	F. MINOR

References

List name and telephone number of three business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list three school or personal references who are not related to you.

NAME TELEPHONE NUMBER OF YEARS KNOWN

( )

( )

( )

Additional Information

List professional, trade, business or civic associations and any offices held. EXCLUDE MEMBERSHIP THAT WOULD REVEAL RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, CITIZENSHIP, AGE, MENTAL OR PHYSICAL DISABILITIES, VETERAN/RESERVE NATIONAL GUARD OR ANY OTHER SIMILARLY PROTECTED STATUS.

ORGANIZATION OFFICES HELD

List special accomplishments, publications, awards, etc. EXCLUDE MEMBERSHIP THAT WOULD REVEAL RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, CITIZENSHIP, AGE, MENTAL OR PHYSICAL DISABILITIES, VETERAN/RESERVE NATIONAL GUARD OR ANY OTHER SIMILARLY PROTECTED STATUS.

List any additional information you would like us to consider.

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i)cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume of job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have no heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant ____________________________ Date _____/_____/______