Date __________________________________
Name _______________________________________________________________________________________________
(First)
(Middle)
(Last)
Address _____________________________________________________________________________________________
(Number)
(Street)
_____________________________________________________________________________________________
(City)
(State)
(Zip Code)
______________________________
(Home Phone Number)
______________________________
(Cell Phone Number)
_________________________
(Email Address)
List previous addresses within last 5 years
Are you over 18 years of age? ____ Yes
____ No
If no, can you supply a work permit? ____Yes
Do you have the legal right to remain and work in the United States?
_____ Yes
____ No
_____ No
NOTE: You will be required to submit proof of your identity and employment authorization as a condition of employment.
Have you been employed here previously? _____ Yes
_____ No
If yes, when ________________________________
Do you have friends or relatives employed by us?
_____ Yes
_____ No
If yes, who and what is their relation? _____________________________________________________________________________
Position Applied For _________________________________________
Salary Requirement __________________________
Available For:
Date Available For Work ______________________
_____ Full-Time
_____ Part-Time
If Part-Time, please state days/hours available ____________________________________________________________________
How were you referred?
_____ News Ad
_____ Customer
_____ Employee
_____ Other
In accordance with state and federal laws, Granite Bank provides equal employment opportunity.
Employment decisions are made without regard to age, race, national origin, color, sex, sexual orientation,
marital status, gender identity, physical or mental disability or veteran status.
GENERAL INFORMATION:
Name by which you are known to references if different from present name _____________________________________
Have you been convicted of a crime other than misdemeanors or summary offenses that has not been annulled? _____ Yes_____ No
If yes, please explain the specific nature of the offense(s) and surrounding circumstances, including your age at the time of conviction
and any rehabilitation
NOTE: Conviction of a crime will not automatically result in your disqualification from consideration for employment. The seriousness
of the crime, date of conviction, etc. will be considered in relation to the particular position(s) available or for which you have applied.
Have you served in the US Armed Forces? _____ Yes
_____ No
If yes, when ____________________________
Please list any relevant training and/or education
Please describe the skills you feel qualify you for employment with our organization:
EDUCATION:
Years Completed
Degree Received
High School:
Name ________________________________
1
2
3
4
____________________________
College:
Name ________________________________
1
2
3
4
____________________________
Other:
Name ________________________________
1
2
3
4
____________________________
EMPLOYMENT HISTORY:
Please complete all requested information beginning with your most recent employer. You may also attach a resume.
From
To
Employer Name
Telephone
___________________________________________________________________________________________________________
Job Title
Address
____________________________________________________________________________________________________________
Immediate Supervisor and Title
Summarize position title and job responsibilities
___________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Reason for Leaving
Hourly Rate/Salary
Start $
May we contact your employer? _____ Yes_____ No
per
Ending $
per
From
To
Employer Name
Telephone
___________________________________________________________________________________________________________
Job Title
Address
____________________________________________________________________________________________________________
Immediate Supervisor and Title
Summarize position title and job responsibilities
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Reason for Leaving
Hourly Rate/Salary
Start $
per
Ending $
per
May we contact your employer? _____ Yes_____ No
From
To
Employer Name
Telephone
____________________________________________________________________________________________________________
Job Title
Address
____________________________________________________________________________________________________________
Immediate Supervisor and Title
Summarize position title and job responsibilities
___________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Reason for Leaving
Hourly Rate/Salary
Start $
per
Ending $
per
May we contact your employer? _____ Yes_____ No
REFERENCES:
Please provide the names of three business references who would be in addition to present or past supervisors:
Name
Company Name
Telephone
Years Known
____________________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
PLEASE READ CAREFULLY
I hereby certify that the information provided on this application (and accompanying resume, if any) is true and complete to the best of
my knowledge and agree that falsified information or significant omissions may disqualify me from further consideration for
employment and will be considered grounds for immediate discharge if discovered at a later date. I understand that this application for
employment does not constitute an employment contract and that if hired, I will be an at-will employee, meaning that I can terminate my
employment or the Bank can terminate my employment at any time, with or without cause or notice. I authorize you to conduct any
necessary and reasonable investigation with respect to my application, including my financial and credit records, and release my former
employers, Granite Bank and its officers, agents and employees from any liability from damage caused by giving and receiving
information or opinions as to my employment or character. As a condition of employment, I understand that Granite Bank may perform
random credit record checks. As a further condition of employment, I agree to conform to the policies and procedures of Granite Bank.
Date _____________________
Signature of Applicant _____________________________________________________
Applicant Information (Applicant should keep this form)

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate,
incomplete, or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting
agency may continue to report information it has verified as accurate.

Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency
may not report negative information that is more than seven years old,, or bankruptcies that are more than ten years old.

Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid
need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies
those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out
information about you to your employer, or a potential employer, without your written consent given to the employer. Written
consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.

You may limit “prescreened” offers of credit and insurance you get based on information in your credit report.
Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to
remove your name and address from the lists these offers are based on. You may opt out with the nationwide credit bureaus at
1-800-772-0130.

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a
furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more information, visit
www.consumerfinance.gov/learnmore.
States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights
under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For
information about your federal rights, contact:
FDIC
15 Braintree Hill Office Park
Suite 100
Braintree, MA 02184-8701
1-866-728-9953
CONSUMER/CREDIT REPORT AUTHORIZATION
I understand that in connection with my application for employment and, if hired, during the course of my
employment, a consumer report may be obtained for employment purposes.
The consumer report may include, but not be limited to, information from credit checks, motor vehicle record
checks, criminal history searches, education verifications, employment verifications and reference checks.
In addition, I understand the Bank intends to obtain a credit report to be used in connection with the Bank’s
consideration of my application for employment.
In the event that information from my credit report results in a decision by the Bank not to extend an offer of
employment, I will be provided with a copy of my credit report and an FTC notice of rights form.
As evidenced by my signature below, I authorize Granite Bank to obtain a consumer and credit report to be used
in connection with the Bank’s consideration of my application for employment.
____________________
Date
_______________________________
Applicant’s Signature
_
Applicant’s Date of Birth
________________________________
Applicant’s Social Security Number
GRANITE BANK
APPLICATION FOR EMPLOYMENT
AN EQUAL OPPORTUNITY EMPLOYER
WE CONSIDER APPLICANTS FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX,
NATIONAL ORIGIN, AGE, OR ANY NON-JOB RELATED DISABILITY. EQUAL ACCESS TO PROGRAMS,
SERVICE AND EMPLOYMENT IS AVAILABLE TO ALL PERSONS. THOSE APPLICANTS REQUIRING
REASONABLE ACCOMMODATION TO THE APPLICATION AND/OR INTERVIEW PROCESS SHOULD
NOTIFY THE INDIVIDUAL RESPONSIBLE FOR HUMAN RESOURCES.
THIS APPLICATION WILL BE GIVEN EVERY CONSIDERATION, BUT ITS RECEIPT DOES NOT IMPLY
THAT THE APPLICANT WILL BE EMPLOYED. APPLICATIONS WILL BE CONSIDERED FOR VACANCIES
WHICH ARISE DURING THE 60 DAY PERIOD FOLLOWING SUBMISSION. APPLICANTS SHOULD
COMPLETE AN UPDATED APPLICATION IF NOT CONTACTED AND/OR HIRED DURING THIS 60 DAY
EVALUATION PERIOD.
PLEASE COMPLETE THIS FORM CAREFULLY IN YOUR OWN HANDWRITING. REPLIES TO ALL QUESTIONS
WILL BE HELD IN STRICTEST CONFIDENCE. IF YOUR ANSWERS OR STATEMENTS REQUIRE ADDITIONAL
SPACE, OBTAIN SUPPLEMENTAL SHEETS FROM THE RECEPTIONIST.
IN ORDER TO BE CONSIDERED FOR EMPLOYMENT, THIS APPLICATION MUST BE COMPLETED IN FULL.
PLEASE INDICATE THE SPECIFIC JOB TITLE FOR WHICH YOU ARE INTERESTED IN BEING
CONSIDERED. INDIVIDUALS WHO EXPRESS AN INTEREST IN “ANY” POSITION, OR A GENERIC TITLE
WILL NOT BE CONSIDERED FOR EMPLOYMENT.
THE BANK IS COMMITTED TO MAINTAINING A WORKPLACE FREE OF THE PROBLEMS ASSOCIATED WITH
DRUG OR ALCOHOL ABUSE. AS SUCH, ALL APPLICANTS ARE REQUIRED TO UNDERGO TESTING AS PART OF
THE PRE-EMPLOYMENT PROCESS. IF YOU CURRENTLY USE ILLEGAL DRUGS, WE SUGGEST THAT
YOU NOT COMPLETE THE APPLICATION PROCESS. A POSITIVE DRUG TEST WILL RESULT IN
DISQUALIFICATION FROM EMPLOYMENT OR WITHDRAWAL OF ANY EMPLOYMENT OFFER.
POSITION SOUGHT: ______________________________________
DATE: ___________________________________________________
GRANITE BANK
APPLICANT DATA RECORD
Applicants and Employees are treated during
employment without regard to race, color, religion, sex,
national origin, age, marital or veteran status, medical
condition or handicap/disability, or any other legally
protected status.
Solely to help us comply with governmental record
keeping, reporting and other legal requirements, we
request that you please fill out the Applicant Data
Record. We appreciate your cooperation.
We comply with government regulations, including
affirmative action responsibilities where they apply.
This data is for periodic government reporting and will
be kept in a Confidential File separate from the
Application for Employment. YOUR COOPERATION
IS VOLUNTARY.
PLEASE PRINT
Date
Position Applied For
Name
(
Last
First
Middle
) Phone
Area Code
Address
Number
Referral Source:
Street
City
Advertisement
Friend
Employment Agency
Walk In
State
Zip Code
Relative
Other
CONFIDENTIAL INFORMATION
VOLUNTARY SURVEY
Various government agencies request statistical information regarding our hiring practices. Your cooperation in completing this form is completely
voluntary. Any information gathered is strictly confidential and will not subject you to coercion or intimidation relating to your status. Failure to
provide this information will not adversely affect your application. Thank you for your cooperation.
Check One:
Male
Female
Check one of the following Race/Ethnic Groups:
Hispanic or Latino
Other
If other, check one of the following Race/Ethnic Groups:
White
Black or African American
Asian
Two or more Races
Native American Indian/Alaskan Native
Native Hawaiian or Other Pacific Islander
If Native American Indian, check if any of the following are applicable:
Formal member of a particular tribe
Have a membership card issued by the tribe
Have a Certificate of Degree of Indian Blood issued by the Bureau of Indian Affairs
Are considered an American Indian in your community
Used American Indian School or hospital
I am:
1.
A Disabled Veteran
Yes
No
2.
An Armed Forces Service Medal Veteran
Yes
No
3.
A Recently Separated Veteran
Yes
No
4.
An Active Duty Wartime or Campaign Badge
(Other Protected) Veteran
Yes
No
Definitions:
1.
A Disabled Veteran means (i) 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 (ii) a person who was discharged or released from active
duty because of a service-connected disability.
2.
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 (61 Fed. Reg. 1209) at
http://www.opm.gov/veterans/html/vgmedal2.asp.
3.
Recently Separated Veterans 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.
4.
Active Duty Wartime or Campaign Medal (Other Protected) Veterans 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. For those with Internet access, the information required to make this
determination is available at http://www.opm.gov/veterans/html/vgmedal2.htm. Information also may be
obtained by sending an email to [email protected] or by calling (301) 306-6752.