First Northern Bank & Trust

Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national Origin, age, disability, marital or veteran status, or any other legally protected status.

*Required Field

First Name*
Middle Name
Last Name*
Address*
City*
State*	<Select a State> Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip*
Phone*
Cell Phone
Email
Drivers License #*
Drivers License State*	<Select a State> Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Position
Applying For	Full TimeTemporary Part TimeSeasonal

Indicate which locations you would like to be considered*

Palmerton, PASciota, PA
Egypt, PAMt. Bethel, PA
Northhampton, PAStroudsburg, PA
Bath, PATannersville, PA
Wind Gap, PABlakeslee, PA
Gilbert, PA

How did you hear about us?*

AdvertisementWalk-in
Employment AgencyEmployee Referral
WebsiteOther

Referred By

If you are under 18 years of age, can you provide required proof of your eligibility to work?	YesNo
Have you ever been employed with us before?	YesNo
If Yes, give date
Are you currently employed?	YesNo
May we contact your present employer?	YesNo
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? Proof of citizenship or immigration status will be required upon employment.	YesNo
On what date would you be available to work?
Are you available to work…	Full time Part time
Are you currently on "lay off" status and subject to recall?	YesNo
Do you have a dependable means of transportation to and from work?	YesNo
Have you been convicted of a felony within the last 7 (seven) years?	YesNo
If Yes, please explain

Availability to work

Shift	Mon	Tues	Wed	Thurs	Fri	Sat
Morning
Afternoon

Education

School	Name	Study	Did you graduate?
High School/GED
Undergraduate
Graduate
Other

References

Name	Address	Phone Number

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer
Employed Date From	To
Work Performed
Address
City
State	<Select a State> Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Phone
Hourly Rate/Salary Starting	Hourly Rate/Salary Ending
Job Title
Supervisor
Reason for Leaving

Employer
Employed Date From	To
Work Performed
Address
City
State	<Select a State> Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Phone
Hourly Rate/Salary Starting	Hourly Rate/Salary Ending
Job Title
Supervisor
Reason for Leaving

Employer
Employed Date From	To
Work Performed
Address
City
State	<Select a State> Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Phone
Hourly Rate/Salary Starting	Hourly Rate/Salary Ending
Job Title
Supervisor
Reason for Leaving

Employer
Employed Date From	To
Work Performed
Address
City
State	<Select a State> Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Phone
Hourly Rate/Salary Starting	Hourly Rate/Salary Ending
Job Title
Supervisor
Reason for Leaving

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I authorize a credit history and/or background check to be conducted if desired by the Employer. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applicants are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an 'at will' nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time without cause. It is further understood that this 'at will' employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also that I am required to abide by all rules and regulations of the employer.