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Notice: Your application is in a secure site (look for
the graphic of a lock at the bottom of your browser window),
and the information you are sending is protected.
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We are gathering the following information to help us
accurately comply with Federal Equal Employment Opportunity
requirements and to assist us in developing and monitoring
our Affirmative Action Program. We are asking you to help us
in our efforts by providing certain information about
yourself. This information is confidential and will be
retained separate from your employment application and used
for reporting purposes only. This information will not be
used in any way that could adversely affect your employment,
compensation, promotions or transfer opportunity or other
conditions of employment.
Completion of this form is not required of you. If you choose
not to respond, you will not be subject to adverse treatment.
However, you should know that we are required by Federal
regulation to record this information about all employees
based upon visual observation or any other information we may
have.
I agree to the statement above.
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I am identifying myself as follows:
Are you Hispanic or Latino?
Race:
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PEFCU employment policies and practices do not discriminate
because of race, color, religion, age, sex, national origin,
disability, marital status, sexual preference,ancestry,
student status or veteran status. PEFCU will comply with its
obligation to provide reasonable accommodations to qualified
individuals with disabilities.
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We appreciate your interest in Purdue Employees Federal
Credit Union and assure you that we are sincerely interested
in your qualifications. Applicants who need accommodations
for an interview should request this in advance.
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Personal Information
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Last Name:
First Name:
Middle Initial:
Current Address:
City:
State:
Zip Code:
Social Security Number:
Home Phone #:
Work Phone #:
Email:
Are you at least 18 years of age?
If no, list your date of birth
Are you legally eligible for employment in the U.S.A.? Proof
will be required.
Were you previously employed by PEFCU?
If yes, when?
Do you have any criminal convictions or pending criminal
charges?
Details
NOTE: A conviction of a crime or a pending charge will be
considered as it relates to fitness to perform the job being
sought.
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Employment Interest
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Position Desired:
Hours Desired:
Date Available: Month:
Year:
If part-time, what hours and days are you available?
Salary Desired:
How were you referred to PEFCU?
Other Specify :
Are you related to any employee of PEFCU? If yes, list name &
relationship:
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Education
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High School :
Name and Address of School:
Course of Study:
Years Completed:
Diploma/Degree:
Undergraduate College :
Name and Address of School:
Course of Study:
Years Completed:
Diploma/Degree:
Graduate/Professional :
Name and Address of School:
Course of Study:
Years Completed:
Diploma/Degree:
Other (Specify) :
Name and Address of School:
Course of Study:
Years Completed:
Diploma/Degree:
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Employment History
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Employer:
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Dates Employed:
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From:
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Month:
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Year:
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To:
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Month:
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Year:
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Work Performed:
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Address:
Telephone #:
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Starting/present job title:
Supervisor:
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Hourly Rate/Salary
Starting:
Final:
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Reason For Leaving:
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May we contact?
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Employer:
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Dates Employed:
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From:
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Month:
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Year:
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To:
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Month:
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Year:
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Work Performed:
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Address:
Telephone #:
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Starting/present job title:
Supervisor:
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Hourly Rate/Salary
Starting:
Final:
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Reason For Leaving:
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May we contact?
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Employer:
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Dates Employed:
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From:
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Month:
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Year:
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To:
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Month:
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Year:
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Work Performed:
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Address:
Telephone #:
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Starting/present job title:
Supervisor:
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Hourly Rate/Salary
Starting:
Final:
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Reason For Leaving:
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May we contact?
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Employer:
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Dates Employed:
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From:
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Month:
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Year:
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To:
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Month:
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Year:
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Work Performed:
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Address:
Telephone #:
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Starting/present job title:
Supervisor:
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Hourly Rate/Salary
Starting:
Final:
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Reason For Leaving:
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May we contact?
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Please add any additional comments desired and include
explanation of any gaps in employment.
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Additional Skills and Activities
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Foreign Languages Spoken / Written (optional-Foreign Language
proficiency is occasionally helpful).
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If you have additional skills and/or computer software
knowledge that you feel would be applicable to the position
for which you are applying, please list here:
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Please list any extra-curricular activities, responsibilities,
or leadership positions that have equipped you with any other
relevant job skills. You may exclude membership which would
reveal gender, race, religion, national origin, age, ancestry,
disability, or other protected status.
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Are you currently, or have you ever served in the U.S. Armed
Forces?
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If yes, what branch?
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Professional References (Please do not
include family members)
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Name:
Relationship To Reference:
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Phone Number:
Years Known:
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Name:
Relationship To Reference:
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Phone Number:
Years Known:
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Please Note: You are not required to answer this
question until you have been informed about the essential
duties of the position for which you are applying.
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Are you capable of performing, with or without a reasonable
accommodation, the activities involved in the position for
which you have applied? A review of the activities involved
in such a position has been given.
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Fair Credit Reporting Act Notice
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This is to inform you that as part of our procedure for
processing your employment application, we may obtain a
consumer report and or an investigative consumer report which
includes information as to your character, general reputation,
personal characteristics, and mode of living. If an
investigative report is requested, you have the right to make
a written request within a reasonable period of time for a
complete and accurate disclosure of additional information
concerning the nature and scope of the investigation.
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I agree to the statement above.
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Application Statement
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I certify that all statements on this application for
employment are true and complete. In the event of employment,
I understand that false or misleading information given in my
application or interview(s) may result in termination. I
understand that this employment application and any other
company documents are not contracts for employment, that my
employment and compensation can be terminated with or without
cause, and with or without notice, at any time at the option
of either the employer or myself. I understand that no
representative of PEFCU has the authority to enter into any
agreement for employment for any specified time, or to make
any agreement to the contrary.
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I agree to the statement above.
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