Application for At-Will Employment

Please fill out this secure application as completely as possible, read the Authorization, and then check the box at the bottom of the form before submitting. Please note that it may not be possible to consider or process incomplete applications. Thank you.

Date Submitted 4/23/2019
Full Name



Position(s) Desired any specifically:
Acceptable Statuses full-time part-time
(at least but less than hours per week)
Acceptable Locations Bolivar - downtown
Bolivar - west
Fair Grove
Springfield - east
Springfield - south
Rate of Pay Desired
Date You Could Start
Referred to BOB By



Permanent Address
City, State, and Zip
Primary Phone #



Employment History (last 4 employers, most recent one first)

Employer Name & Address Position Rate of Pay   Dates Worked Reason for Leaving
Are you currently employed?
Ever applied to BOB before? (If so, when: )



Education History

  School Name & Location Degree Earned Subject Areas Degree/Diploma Completed? (Y/N)
High School:



Job-Related Skills & Qualifications



References (3 people not related to you whom we can contact)

Name & Address Phone Number Nature of Relationship Years Known




I certify that all information provided by me on this application is true and complete to the best of my knowledge. I understand that incorrect or falsified information provided by me could be grounds for the rescission of any employment offer or grounds for dismissal if I were to be employed by Bank of Bolivar (also referred to herein as the “Bank”).

I authorize Bank of Bolivar to investigate all statements provided by me herein and I hereby release all references and employers listed above to speak with the Bank concerning my current or prior employment plus any other pertinent information they may offer – personal or otherwise. I realize that, due to bank security concerns, a separate “Consent & Release for Background Check” form must be completed before I can be considered for employment with Bank of Bolivar and that the Bank will use this information in its hiring considerations. I release Bank of Bolivar from all liability for any damage that may result from the utilization of all such information mentioned above.

I understand and agree that employment is not offered by Bank of Bolivar until a formal letter of offer signed by the Bank president or other designated officer is presented to the applicant, and that no representative of the Bank is authorized to make an offer of employment by any other means.

I further understand that employment with Bank of Bolivar is considered to be “at will” and that all offers and/or employment may be terminated for any legal reason by either party at any time.

Finally, I understand that Bank of Bolivar is an equal opportunity employer and does not discriminate based on any prohibited grounds.

I understand and agree to all of the terms in the “Authorization” section above.