Employment Application

Personal Information

• First Name
  OK First Name is required
• Middle Initial
  Optional OK Middle Initial is required
• Last Name
  OK Last Name is required
• Street Address
  OK Street Address is required
• City
  OK City is required
• State
  OK State is required
• Zip Code
  OK Zip Code is required

• Home Phone

  - -
  Optional OK Home Phone is required

• Work Phone

  - -
  Optional OK Work Phone is required

• Cell Phone

  - -
  Optional OK Cell Phone is required
• Email Address
  OK Email Address is required

• Are you a citizen of the U.S. or can you submit verification of your legal right to work in the U.S.?

  • No
  • Yes
  OK Are you a citizen of the U.S. or can you submit verification of your legal right to work in the U.S.? is required

General Information

• Position Applying for
  OK Position Applying for is required
• Salary Requirements
  OK Salary Requirements is required

• Date Available

  JanFebMarAprMayJunJulAugSepOctNovDec 12345678910111213141516171819202122232425262728293031 202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068206920702071207220732074
  OK Date Available is required
• Work Status Desired Full-timePart-timeTemporarySummer
  OK Work Status Desired is required
• If seeking part-time, please list hours available Monday - Saturday
  Optional OK If seeking part-time, please list hours available Monday - Saturday is required

• Could you travel if required?

  • Yes
  • No
  OK Could you travel if required? is required

• Have you ever submitted an application for employment here before?

  • Yes
  • No
  OK Have you ever submitted an application for employment here before? is required
• If yes, when?
  OK If yes, when? is required

• Have you ever been employed here or with any of our affiliates?

  • Yes
  • No
  OK Have you ever been employed here or with any of our affiliates? is required
• If yes, when and where?
  OK If yes, when and where? is required

• Are you related to anyone currently employed by our organization?

  • Yes
  • No
  OK Are you related to anyone currently employed by our organization? is required
• If yes, please list name(s) and relationship(s)
  OK If yes, please list name(s) and relationship(s) is required

• Referral Source (please check all that apply)

  • PCSB Bank Web Branch
  • Walk - In
  • Staffing Agency
  • Newspaper Ad
  • Government Agency (Iowa Workforce Agency)
  • Other
  OK Referral Source (please check all that apply) is required
• Referred by
  OK Referred by is required

Section 19 of the FDIA (Federal Deposit Insurance Act) prevents banks and other financial institutions from hiring or employing individuals who have been convicted of, or entered into a pretrial diversion program for, any criminal offense involving dishonesty or breach of trust or money laundering. A conviction does not automatically prevent you from employment.

• Have you ever been convicted of or plead guilty to an above offense?

  • No
  • Yes
  OK Have you ever been convicted of or plead guilty to an above offense? is required
• If yes, use the space below to provide more information including conviction, sentence and date of occurence.
  Optional OK If yes, use the space below to provide more information including conviction, sentence and date of occurence. is required

Professional References

Reference #1

• Name
  OK Name is required
• Title
  Optional OK Title is required
• Company Name and Address
  OK Company Name and Address is required

• Work Phone

  - -
  OK Work Phone is required
• Email
  OK Email is required

Reference #2

• Name
  OK Name is required
• Title
  Optional OK Title is required
• Company Name and Address
  OK Company Name and Address is required

• Work Phone

  - -
  OK Work Phone is required
• Email
  OK Email is required