Online Employment Application

As a condition of employment, Liberty Bank and Trust Company requires that applicants consent to a criminal investigation, credit check, and undergo a drug-screening test. Positive test results from the drug screening process will disqualify applicants from further employment consideration. Liberty Bank reserves the right to request a criminal investigation, credit check, or drug screening test at any time during an employee's tenure with the Bank.

If you prefer to fill out the application offline, click here to download the application in pdf format.

Basic Information:

First Name:	Last Name:	Middle:
Address: (Number & Street):	City:	State:	Zip Code:
Home Phone Number:	Mobile Phone Number:	Office Phone Number:	Social Security Number:
()--	()--	( )--	()
Position(s) applying for:		Date of Application:
Date Available:		Salary Desired:
How did you learn about us? Advertisement School Internet Walk-in Friend Employee Referral		State/Hours desired: Full-time Part-time

If you are under 18 years of age, can you provide a work permit?	Yes	No
Do you have any relatives currently employed by Liberty Bank?	Yes	No
If yes, please provide name and relationship:
Have you ever been employed by us before?	Yes	No
If yes, please provide date and position:
Can you provide the required proof of U.S. citizenship or work eligibility?	Yes	No
Have you ever been convicted of a criminal offense, pled guilty, or nolo contend ere (no contest), other than for a minor traffic violation?	Yes	No
If yes, please explain:
Have you ever been discharged, resigned or been asked to resign from a job due to suspicion of theft or unauthorized possession of property or similar conduct?	Yes	No
If yes, please explain:

Education:

	Name of Institution	Diploma/ Degree	Major	Year Graduated or Last Attended
High School
Business School
College/University
Military

Special Skills, Training or Qualifications:
Describe any specialized skills, training, or apprenticeships you have been involved in including military training:
Do you have any of the following skills: (Check all that apply.)

Typing, wpm	Personal Computer: Beginner Intermediate Advanced User
Teller Terminal	Word Processing Software: Word WordPerfect Works Other
10-Key Adding Machine	Spreadsheet: Excel Lotus 123 Other

Professional Organizations, Business, Civic or Community Activities:
Describe any activities you feel may be helpful to use in considering your application for employment. You may exclude any information that reveals race, sex, religion, national origin, age, ancestry or handicap or other protected classes.

Personal References:
Please provide the names, addresses and telephone numbers of at least three personal references that may be contacted to provide a character reference and who are not relatives or previous supervisors:

	Name	Relationship	Phone Number
1.
2.
3.

If you are currently employed, may we contact your present employer? Yes No

Employment History
This section must be completed. (Resumes can be submitted as supplemental information.)

Current or Most Recent Employer:		Start Date: To:
Address:		Current/Final Pay Rate:
Job Title:		Phone Number:	() - -
Major Duties:
Supervisor:		Reason for Leaving:

Previous Employer:		Start Date: To:
Address:		Current/Final Pay Rate:
Job Title:		Phone Number:	() - -
Major Duties:
Supervisor:		Reason for Leaving:

Previous Employer:		Start Date: To:
Address:		Current/Final Pay Rate:
Job Title:		Phone Number:	() - -
Major Duties:
Supervisor:		Reason for Leaving:

Previous Employer:		Start Date: To:
Address:		Current/Final Pay Rate:
Job Title:		Phone Number:	() - -
Major Duties:
Supervisor:		Reason for Leaving:

Voluntary Affirmative Action Information
(Completion of the information below is voluntary) We are required to comply with government regulations concurring Affirmative Action obligations where they apply. In an effort to comply with these requirements, we must provide the government with an applicant flow report. The information provided on this form will not be used as a part of your application for employment and will be maintained separate and apart from applicant files. This applicant data survey contains confidential information and will be maintained according. Your cooperation and assistance is appreciated.

Position applied for:

Date:

Referral Source: (Please check one.)

Advertisement	Government Agency	Walk-in
Employment Agency	Relative	Referral,
Friend	School	Community Agency

Applicant Information:

Last Name:	First Name:		Middle:
Address: (Number & Street):	City:	State:	Zip Code:
Phone Number:	Gender: Male Female
()--

Equal Employment Opportunity Identification Groups: (Please check one.)

White	Black (not of Hispanic origin)	Hispanic
American Indian/Alaskan Native	Asian/Pacific Islander

Vietnam Era Veterans, Disabled Veterans and Individuals with Physical/Mental Disabilities: (Please check one.)

Vietnam Era Veteran (served between 1964 and 1975)

Disabled Veteran

Individual with a disability

Drug Test Consent and Release Form

I, hereby voluntarily consent to submit to a drug test at the request and expense of Liberty Bank. It is understood that I am submitting to this test of my own free will. I give permission to the testing laboratory to release my test results to Liberty Bank. I further understand that refusal to submit to this test will be considered voluntary withdrawal of my employment application.

I am taking or have taken the following medication within the past days:
Name of Medication:	Condition for which taken	Prescribing Physician
This form will be submitted over a secure connection.

I hereby authorize all treating physicians to verify the prescriptions listed above by date, usage and condition prescribed. I understand that the results of my drug test will be held in strict confidence and that only Liberty Bank management with hiring responsibility and Human Resources will have access to the results.

Credit Check Consent and Release Form

I, hereby voluntarily consent to Liberty Bank and Trust Company conducting a credit check as a part of their employment process and understand that for employment purposes, may obtain consumer reports on me from time to time during my employment. I understand that I will receive a copy of the credit bureau report for my information. When the information contained in my report may affect my employment status, I will be given an opportunity to respond in writing within five business days to any derogatory or inaccurate information contained in my report. My correspondence must be directed to the Vice President, Human Resources. It is also my responsibility to contact the appropriate credit reporting agencies to correct any discrepancies.

I hereby authorize Liberty to conduct an investigation of my credit history. I understand that the results of that investigation will be held in strict confidence and that only Liberty Bank Management with hiring responsibility and the Human Resources Department will have access to the results.