I hereby authorize Texoma Educators Federal Credit Union to conduct a comprehensive review of my background causing a consumer report and/or an investigative report to be generated for employment purposes.

I understand that the scope of the consumer report / investigative consumer report may include, but not limited to the following areas:

Verification of social security number; current and previous residences; employment history including all personnel files; character references; credit history and reports; criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; birth records; motor vehicle records to include traffic citations and registration; and any other public records.

Please complete the form below. Mandatory fields marked *

1. First Name *
2. Middle Name
3. Last Name *
4. Maiden Name
5. Former Names

Current Address

1. Since * Month/Year, i.e. 12/06 for December 2006
2. Street (no PO box) *
3. City *, State * ,
4. Zip *

Most Recent Prior Address

1. Since Month/Year, i.e. 12/06 for December 2006
2. Street (no PO box)
3. City, State ,
4. Zip

Second Most Recent Prior Address

1. Since Month/Year, i.e. 12/06 for December 2006
2. Street (no PO box)
3. City, State ,
4. Zip

Identification and Contact Information

1. Social Security Number *
2. Date of Birth * for I.D. purposes only
3. Drivers License Number, State ,
4. License Expiration Date
5. Telephone Number
6. Cell Phone Number
7. Email Address

1. Are you at least 18 years old? *

   Yes No
2. Are you a U.S. citizen? *

   Yes No
3. If you are not a citizen, do you have the legal right to work in the U.S. (i.e. green card)?

   Yes No
4. How many addresses have you had in the last 5 years?
5. How did you find out about this job?

   Newspaper Referral Other
6. If hired, do you have a reliable means of transportation to get to work?

   Yes No

1. What type of work are you seeking? *

   Temporary Full time Part time
2. Are you willing to work...

   ...overtime? ...weekends? ...holidays?
3. What position(s) are you applying for?
4. When can you start?
5. When are you available to work?
6. When are you unavailable?
7. Salary desired
8. Least acceptable salary

Experience, special skills, or training

1. Are you currently employed? *

   Yes No
2. Are you on layoff and subject to recall?

   Yes No
3. Have you worked for this organization before? *

   Yes, under this name: No
4. List any friends or relatives employed by this company:
5. Have you ever been discharged or asked to resign from any position?

   Yes No
6. If you have, please describe:
7. How many days have you missed from school or work within the last 12 months?
8. How many days have you been late to school or work within the last 12 months?
9. How many days have you missed in the last 3 years for reasons other than sickness?
10. Please describe:

1. Highest level attained: * - please select - Elementary - 1st grade - 2nd grade - 3rd grade - 4th grade - 5th grade - 6th grade - 7th grade - 8th grade High School - 9th grade - 10th grade - 11th grade - 12th grade HS Diploma / G.E.D. Bachelor's Degree Master's Degree
2. School Name and City
3. Degree and Major
4. If you are in high school, are you in a recognized co-op program, such as D.E., C.V.A, or V.O.E.?

   Yes No
5. If yes, which program and school?

Military Service

1. Are you a veteran?

   Yes No
2. If yes, when did you serve? from to
3. Special skills or training:

Additional Employment Information

1. May we contact the employer(s) listed above?

   Yes No
2. If not, tell us which one(s) you do not wish us to contact and why:
3. How many jobs have you had in the last 10 years that are not listed above?
4. Outside interests, including organizations you're active in that are business related:

Criminal Background

1. Bonding and money handling security policies require that we ask if you have ever pled guilty,
   nolo contendere (no contest), or been convicted of burglary, robbery, crime of violence against
   another person or any other criminal charge? *

   Yes No
2. Are you or have you ever been on parole or probation? *

   Yes No
3. Are you currently awaiting trial? *

   Yes No
4. If yes, state the nature of the offense and disposition of the case. Include dates and places.

NOTE: Felony convictions or the existence of a criminal record does not constitute an automatic bar to employment.

I authorize this company to make an investigation of all information contained in this application for employment and I release from all liability all companies and corporations supplying such information. I understand that any false answers, statements or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record and any other investigative report they deem necessary through various third party sources. Upon my formal written request, within a reasonable period of time, I will be notified as to the nature and scope of such investigation. I realize I hereby agree to any drug test that may be required of me prior to my employment or if employed by this company at any time thereafter. If requested, I will take a physical examination post job offer and employment will be conditional upon passing such examination. During such employment, I understand and agree that in the event that I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company designated physician. I further understand that this is an application for employment and that no employment contract is being offered. I understand that if I am employed, such employment is for an indefinite period of time and that the company may change wages, benefits and conditions at any time. My employment is at will. I have read and understand the above.

1. I have read and agree to the above. *
2. Security phrase *
   
   Please enter the text as it appears below: