Terre Haute Savings Bank Employment Application

* indicates a required field

Personal Information

*Date
*First Name
*Last Name
*Address
*City, State Zip	,
Permanent Address
City, State Zip	,
*E-mail
*Home Phone Number
Cell Phone Number
Referred by
Are you 18 years of age or older?	Yes No
Have you ever been convicted of a felony involving dishonesty, breach of trust, or theft?	Yes No
If yes, identify the date of each conviction and the offense(s) for which you were convicted.

Employment Desired

*Position
*Date you can start
*Salary Desired
Do you desire?	Full Time Part Time
Are you employed now?	Yes No
May we contact your present employer?	Yes No
Have you ever applied to Terre Haute Savings Bank before?	Yes No
If so, where?
When?

Education

High School

Name and location of school
Last year completed	1 2 3 4
Did you graduate?	Yes No
What subjects were studied and what degree(s) received?

College

Name and location of school
Last year completed	1 2 3 4
Did you graduate?	Yes No
*Are you currently pursuing an Associates, Bachelors or Master's degree?	Yes No
*Are you willing to attend school before and/or after your scheduled work hours at the bank?	Yes No
What subjects were studied and what degree(s) received?

Trade, Business or Correspondence School

Name and location of school
Last year completed	1 2 3 4
Did you graduate?	Yes No
What subjects were studied and what degree(s) received?

General

*Subjects of special study or research work
*Job related skills (typing, driver's license, etc.)

Former Employers

Beginning with your most recent employer, please provide your work history for the past 10 years, or until your high school graduation date.

Name
Address
City, State Zip	,
Reason for leaving
Position
Salary
Date from (mo/year)	to (mo/year)

Name
Address
City, State Zip	,
Reason for leaving
Position
Salary
Date from (mo/year)	to (mo/year)

Name
Address
City, State Zip	,
Reason for leaving
Position
Salary
Date from (mo/year)	to (mo/year)

Professional References

Please list three professional references from your previous employers or school professors.

Name (First M. Last)
Position
Phone Number
Years Acquainted
Address
City, State Zip	,

Name (First M. Last)
Position
Phone Number
Years Acquainted
Address
City, State Zip	,

Name (First M. Last)
Position
Phone Number
Years Acquainted
Address
City, State Zip	,

Diversity

The following information is collected in conjunction with government and record-keeping requirements. It is completely optional for you to submit and will be used only for Equal Opportunity reporting requirements. It is not viewed or used as part of the recruiting or hiring process. Your participation is completely voluntary; you may choose to leave any category blank.

Ethnicity (Please check appropriate box):	Hispanic/Latino Non Hispanic/Latino No Selection
Race (Please check appropriate box):	Asian Black or African American Native Hawaiian or Other Pacific Islander No Selection	White American Indian or Alaska Native Two or More Races
Gender (Please check appropriate box):	Male Female No Selection

Please read the following statement carefully
then scroll down to submit this application.

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by Terre Haute Savings Bank.

I understand that any employment is conditioned on a background check. I authorize Terre Haute Savings Bank to thoroughly investigate all statements contained in my application or resume. Furthermore, I authorize my former employers and references to disclose information regarding my former employment, character, and general reputation to Terre Haute Savings Bank, without giving me prior notice of such disclosure. In addition, I release Terre Haute Savings Bank, any former employers, and all references listed above any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during my interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or Terre Haute Savings Bank. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Terre Haute Savings Bank unless made in writing.

If I am offered employment, I agree to submit to a drug test before starting work. If employed, I also agree to a drug test at any time deemed appropriate by Terre Haute Savings Bank and as permitted by law. I consent to the drug test, and I request that the examining doctor disclose to Terre Haute Savings Bank the results of the test, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, may be contingent upon satisfactory drug tests. If I am hired, a condition of my employment will be that I abide by the Terre Haute Savings Bank's Drug and Alcohol Policy.

I understand that filling out this form does not indicate there is a position open and does not obligate Terre Haute Savings Bank to hire. If hired, I agree to abide by all company work rules, policies and procedures. Terre Haute Savings Bank retains the right to revise its policies or procedures, in whole or in part, at any time.

If Terre Haute Savings Bank hires you, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

TERRE HAUTE SAVINGS BANK is an Equal Opportunity, Affirmative Action Employer and does not discriminate in recruitment, hiring, training, promotion or other employment practices for reasons of age, race, color, religion, national origin, sex, disability, medical condition, protected veteran status, marital status, sexual orientation, gender identity, genetics, or any other non-employment related factor. Reasonable accommodation will be made to enable a qualified individual with a disability to perform the essential functions of the job for which he or she is applying.

Any individuals requiring special accommodations in completing an employment application may contact the Terre Haute Savings Bank Human Resources Department at 812-244-5101.

Employment with Terre Haute Savings Bank is contingent upon a negative drug screen and a satisfactory background investigation. Our background screening may include; education verification, criminal records search, employment history verification and reference confirmation. Our screening may also contain credit information, depending on the position you are applying for at Terre Haute Savings Bank. You have the right to request the information received from our investigation. This request must be made in writing to the Human Resources Department of Terre Haute Savings Bank within a reasonable time after you complete this application.

DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE STATEMENT.
By the check box below, I certify that I have read, fully understand and accept all terms for the foregoing statement. Please signify your acceptance by checking the box below. Clicking the Submit button below will send your application the Human Resources Department at Terre Haute Savings Bank, clicking the Cancel button below will cancel your application and discard all information above.

* I have read and agree to the above authorization statement.

* indicates a required field