Employment Application United Community Bank

EMPLOYMENT REQUEST

Position Applied For:

Minimum Salary Desired:

Preferred Location:

PERSONAL INFORMATION

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

We will use this information for employment purposes and will make reasonable efforts to safeguard your privacy.

GENERAL INFORMATION

Can you briefly explain why you want to be a part of the United Community Bank Team?

Have you ever been convicted of a crime other than minor traffic violations?

Yes

If yes, please provide date(s) and detail:

EDUCATION

HIGH SCHOOL

Institution Name

Years Completed

Field of Study

Graduate or Degree

COLLEGE

Institution Name

Years Completed

Field of Study

Graduate or Degree

GRADUATE SCHOOL

Institution Name

Years Completed

Field of Study

Graduate or Degree

BUSINESS / TECHNICAL

Institution Name

Years Completed

Field of Study

Graduate or Degree

EMPLOYMENT HISTORY

Present or Last Job Title:

Salary or Rate Paid:

Employer:

Business Address

Street Address Address Line 2 City State ZIP Code

Dates of Employment - From:

Dates of Employment - To:

Supervisor's Name:

First Last

Supervisor’s Telephone:

May we contact your for reference?

Yes

Duties (It is not necessary to list job duties if they are described in other documents submitted:

Reason for Leaving:

Second to Last Job Title:

Salary or Rate Paid:

Employer:

Business Address

Street Address Address Line 2 City State ZIP Code

Dates of Employment - From:

Dates of Employment - To:

Supervisor's Name:

First Last

Supervisor’s Telephone:

May we contact your for reference?

Yes

Duties (It is not necessary to list job duties if they are described in other documents submitted:

Reason for Leaving:

Third to Last Job Title:

Salary or Rate Paid:

Employer:

Business Address

Street Address Address Line 2 City State ZIP Code

Dates of Employment - From:

Dates of Employment - To:

Supervisor's Name:

First Last

Supervisor’s Telephone:

May we contact your for reference?

Yes

Duties (It is not necessary to list job duties if they are described in other documents submitted:

Reason for Leaving:

Fourth to Last Job Title:

Salary or Rate Paid:

Employer:

Business Address

Street Address Address Line 2 City State ZIP Code

Dates of Employment - From:

Dates of Employment - To:

Duties (It is not necessary to list job duties if they are described in other documents submitted:

Reason for Leaving:

WORKPLACE / COMPUTER SKILLS AND VOCATIONAL INFORMATION

1. What workplace equipment can you utilize?

2. What software applications do you have a working knowledge of?

3. What special licenses or certifications do you have?

4. What other vocational training have you had?

References

Name:

First Last

Address:

Street Address Address Line 2 City State ZIP Code

Telephone:

Relationship:

Name:

First Last

Address:

Street Address Address Line 2 City State ZIP Code

Telephone:

Relationship:

Name:

First Last

Address:

Street Address Address Line 2 City State ZIP Code

Telephone:

Relationship:

United Community Bank of West KY is an equal opportunity employer. United Community Bank of West KY does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

Digital Signature

Date

Employment applications will be retained on file for 1 year with a Human Resources Representative; They are kept active for 6 months.

INVITATION TO SELF-IDENTIFY

This employer 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.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Self-identify

l identify as one or more of the classifications of protected veteran listed above.

I am not a protected veteran.

I prefer not to self-identify.

Digital Signature

Date

VOLUNTARY APPLICANT SURVEY

Applicants are considered for employment without regard to race, color, sex, sexual orientation, gender identity, religion, age, national origin, disability, veteran's status or any other category protected by federal, state or local statute. As a government contractor, we are committed to compliance with applicable government regulations and affirmative action responsibilities. Solely to helo us comply with government record keeping, reporting and other requirements, we ask that you assist us by completing this Voluntary Applicant Survey. We appreciate your cooperation. This data is for periodic government reporting and will be kept in a Confidential File.

Position(s) Applied For:

Name

First Last

Date

Referral Source:

SUBMISSION OF THIS INFORMATION IS VOLUNTARY

Gender:

Male

Female

Select One of the Following:

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.

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