Application for Employment

Text Size: Small TextMedium TextBig Text

Application for Employment

An Equal Opportunity Employer

It is the policy of Pioneer Bank to afford equal employment opportunities to employ and to advance in employment regardless of a person's age, race, religion, color, national origin, sex, marital status, height, weight, disability, protected veteran status or other protected characteristic. Reasonable accommodation is provided to qualified employees/applicants with disabilities in compliance with state and federal law. Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate form, using a sign language interpreter, or using specialized equipment. If you need a reasonable accommodation in order to complete this application form or any pre-employment tests that may be given, you may voluntarily notify the Human Resources Department. Please click here for information on how to contact Pioneer Bank’s Human Resources Department information

Instructions

The careful completion of this application is an essential step in our consideration of you for employment. You must complete the entire application. Please do not state "See Resume" as a substitute for completing any section of this application. Before you complete and sign this application, please ask the Human Resources Department any questions that you may have.

Initial Contact Information
First Name
Middle Initial
Last Name
Today's Date
Address
City, State, Zip
Phone Number
Cell Phone
Email
(For use in case we
cannot reach you by phone)
Position for Which You Are Applying
Position (Use Specific Title)
Date Available
Are you applying for full-time or part-time employment? Full-Time
Part-Time
Are you seeking seasonal work only? Yes
No
If yes, for what time period?
If seeking branch employment, at which location(s) can you work?

Albany County
Albany Guilderland
Colonie Latham
Glenmont Watervliet
Green Island

Rensselaer County
Brunswick
East Greenbush
Troy
Wynantskill

Saratoga County
Clifton Park East
Clifton Park West
Malta
Waterford

Schenectady County
Rotterdam

Other:

Can You Perform the Essential Functions of the Job for which you are applying, with or without a reasonable accommodation? Yes
No
Wage Expected
Have you ever applied at Pioneer Bank before? Yes
No
If so, for what position?
When?
Are you related to or know anyone who currently works at Pioneer Bank? Yes
No
If yes, please name the individual(s):
Are you presently employed? Yes
No
If yes, where?
Are you subject to recall at another job? Yes
No
If yes, explain.
Referral Source (choose the item(s) and name the specific source): Employee Newspaper
Pioneer Bank Website School
Government Website Job Fair
Other Internet Site Customer
Contacted by Recruiter Former Employee
Department of Labor EOC/One Stop Job Center
Other, specify

 

Education History
High School
Name and Location Course of Study No. of Years
Completed
Graduate? Diploma
or Degree
GPA
College
Name and Location Course of Study No. of Years
Completed
Graduate? Diploma
or Degree
GPA
Other
Name and Location Course of Study No. of Years
Completed
Graduate? Diploma
or Degree
GPA
Other formal education or experience that you believe is relevant to the position for which you are applying:

 

Miscellaneous Information
Are you at least 18 years old? Yes
No
Can you prove that you have current unrestricted authorization to work in the U.S.? Yes
No

Have you ever been convicted of a crime, other than a traffic violation or have you agreed to enter into a pretrial program in connection with a prosecution for such offense? Do not answer "yes" for any conviction for which the record has been judicially ordered sealed, expunged, or statutorily eradicated.

Yes
No
If yes, please explain fully. This information will not necessarily bar an applicant from employment.
What other employment or "sideline" business do you have?
Do you plan to continue it if employed by us? Yes
No
Are you a party to any non-competition, non-solicitation, or other agreement which could restrict your potential activities or employment with us? Yes
No
If Yes, Explain:

 

Skills and Qualifications
Summarize any special training, skills, licenses, and/or certifications, or accreditations that may assist you in performing the position for which you are applying:
Computer skills (check the appropriate boxes and include software title and years of experience):
Word Processing
Years:
E-Mail
Years:
Spreadsheet
Years:
Internet
Years:
Presentation
Years:
Other
Years:

 

Business/Work References
Provide a minimum of 3 business/work references who are not relatives, including names, addresses, occupation, relationship, years known and telephone numbers
Reference 1:
Reference 2:
Reference 3:

 

Employment History
List below past and present employment, starting with most recent. Include employment with U.S. military service. Do not skip any employers.
Name and Address: Phone #:
Position: Last Salary /Wage:
Description of Duties:
Supervisor's Name(s): Dates Employed: to
Reasons for Leaving:
Name and Address: Phone #:
Position: Last Salary /Wage:
Description of Duties:
Supervisor's Name(s): Dates Employed: to
Reasons for Leaving:
Name and Address: Phone #:
Position: Last Salary /Wage:
Description of Duties:
Supervisor's Name(s): Dates Employed: to
Reasons for Leaving:

Applicant Statement

AFFIRMATION. I affirm that the information provided on this application and otherwise provided during the selection process (and accompanying resume, if any) is true and complete. I also agree that any false information, misrepresentations, or omissions may disqualify me from further consideration for employment and may result in termination of my employment if discovered at a later date.

CRIMINAL HISTORY. In addition, I understand that Pioneer Bank may request a criminal history pertaining to me. If such a check will be required, I understand that I will be provided with additional notices and information about that process and my rights.

I voluntarily give Pioneer Bank the right to make a thorough investigation of my past employment, education, training and references, and any licenses or other information I have provided in support of this application. I agree to cooperate in such investigations. I hereby indemnify, release and forever discharge and hold Pioneer Bank, its agents and all persons, companies, or corporations, supplying this information harmless from any and all claims, demands, judgments, and legal fees arising out of or in connection with this investigation, the results, or any lawful use of the results or disclosure thereto.

I understand that this employment application and any other company documents are not contracts of employment and that any individual who is hired can voluntarily leave employment at will and, further, that employment can be terminated by Pioneer Bank at any time with or without cause. Any oral or written statements to the contrary are hereby expressly disavowed and should not be relied upon by any prospective or existing employee.

I certify that if employed, I will produce documents to establish that I am able to work in the United States of America within the required legal limits, typically three (3) business days, and understand that in accordance with the Immigration Reform and Control Act that I will be required to provide timely documentation of identity and employment eligibility.

As an Equal Opportunity / Affirmative Action Employer, Pioneer Bank will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status; a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.

BY CHOOSING "ACCEPT AND SIGN" BELOW, I AM AFFIRMING AND ACCEPTING ALL OF THE ABOVE APPLICANT STATEMENT PROVISIONS AND AM ELECTRONICALLY SIGNING MY EMPLOYMENT APPLICATION. I UNDERSTAND MY ELECTRONIC SIGNATURE IS AS BINDING AS MY HANDWRITTEN SIGNATURE. I HAVE CAREFULLY READ AND UNDERSTAND ALL PROVISIONS OF MY EMPLOYMENT APPLICATION INCLUDING EACH PARAGRAPH OF THE APPLICANT STATEMENT.

BY CHECKING THIS BOX, I AM AFFIRMING AND ACCEPTING ALL OF THE ABOVE APPLICANT STATEMENT PROVISIONS AND AM ELECTRONICALLY SIGNING MY EMPLOYMENT APPLICATION.


 

Equal Employment Opportunity Self-Identification Applicant Survey

Survey of Race – Ethnic Group and Race

Pioneer Bank is an equal opportunity employer and government contractor. It has been and shall continue to be both the official policy and the commitment of Pioneer Bank, including all its divisions to further equal employment opportunities in hiring or employment. Pioneer Bank is committed to the employment and advancement of minorities, females, individuals with disabilities, and veterans. No question on this form is intended to secure information to be used for such discrimination. If you fall into one of these protected classifications, we invite you to identify to yourself and receive coverage under our company’s Affirmative Action Plan.

Completion of this form is voluntary and in no way affects the decision regarding your employment opportunity. Pioneer Bank is required by federal regulations to report information as requested below. The information provided will be held in the strictest confidence, will be maintained in a separate file, and will not be used in a manner inconsistent with the Acts. You may inform us of your status related to the following data or your change in status at this time and/or any time in the future.

Last Name
First Name
Middle Name
Today's Date
Position Applied for
Sex:
Ethnicity Group (check one): Hispanic or Latino
Not Hispanic or Latino
Race (check one): White
American Indian/Alaskan Native
Black or African American
Asian
Native Hawaiian or other Pacific Islander
Two or more races

 

Definitions – Race / Ethnic Groups

Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.

Survey of Protected Veteran Status Applicant Survey

Pioneer Bank is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (“VEVRAA”), which requires Government contractors to take affirmative action to employ and advance in employment:

(1) disabled veterans;
(2) recently separated veterans;
(3) active duty wartime or campaign badge veterans; and
(4) Armed Forces service medal veterans.
These classifications are defined as follows:
  • A “disabled veteran” is one of the following:
    • A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
    • A person who was discharged or released from active duty because of a service-connected disability.
  • A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.
  • An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
  • An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (“VETS”), toll-free, at 1–866–4–USA–DOL.

As a Government contractor subject to VEVRAA, we request this information to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Your decision to provide the relevant information is purely voluntary on your part, and refusal to provide such information will not subject you to any adverse treatment. The information will not be used in a manner inconsistent with VEVRAA, as amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.

I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE
I AM NOT A PROTECTED VETERAN

Voluntary Self-Identification of Disability     Form CC-305
OMB Control Number 1250-005
Expires 1/31/2017
Page 2 of 2

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.1 To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identity as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history of record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular
    dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or
    partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental
    retardation
  • Please check one of the boxes below:

    YES, I HAVE A DISABILITY (or previously had a disability)
    NO, I DON'T HAVE A DISABILITY
    I DON'T WISH TO ANSWER


    ______________________________________
    Your Name

    ______________________________________
    Today's Date
    Voluntary Self-Identification of Disability     Form CC-305
    OMB Control Number 1250-005
    Expires 1/31/2017
    Page 2 of 2

    Reasonable Accommodation Notice

    Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

    ____________________________
    1Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

    PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.


     

    Retype the code from the picture
    CAPTCHA Code Image
    Speak the code Change the code