Employment Application
421 W. Riverside Ave.
Spokane, WA 99201
509.456.8888 • www.inb.com
Inland Northwest Bank does not discriminate in hiring or employment on the basis of race, color, religious creed, national origin, sex, marital status, mental
or physical impairments, or ancestry, or on the basis of age. No question on this application is intended to secure information to be used for such
discrimination. If you require accommodation to complete the application, testing or interview process, please contact the Human Resources Department.
This application must be completed in-full, in order to be considered for an open position.
PERSONAL INFORMATION
Legal Name
POSITION
(middle)
(first)
(last)
Position(s) Applied For:
Preferred Name (if different from above)
Social Security No.
-
Desired Location(s):
-
Present Address
(street)
(city)
(state)
(zip)
Date available for work:
Former Address
(street)
(city)
(state)
(zip)
Salary Requirement:
$
Home Phone
(
Cell Phone
)
-
In case of emergency notify:
(
Relationship
Type(s) of work you will accept:
)
Emergency Phone
(
Yes
Permanent full-time
Permanent part-time
Weekends
On call
)
-
Temporary
Seasonal
Other: ________
_____________
No
Are you at least 18 years of age? If under 18, do you have a work permit?
Yes
No
Can you provide proof that you can be lawfully employed in the United States?
Have you been convicted of any criminal offense involving a felony or misdemeanor in the last 10 years? If yes, indicate nature of offense(s),
date, court and disposition:
Are there any prior commitments that would require your absence of more than a few hours in the next three months? If yes, please explain:
MILITARY SERVICE
Branch of Service
Date In (mo / yr)
Date Out (mo / yr)
Where Served?
Specialty
EDUCATION
NAME OF SCHOOL
LOCATION
GRADUATED? MAJOR / MINOR
DEGREE RECEIVED
High School
Yes
No
Yes
No
Yes
No
Yes
No
College
College
Other
PERSONAL REFERENCES (not former employers)
NAME
RELATIONSHIP (friend, co-worker, teacher, etc.)
PHONE NO.
(
)
-
(
)
-
(
)
-
EMPLOYMENT HISTORY (start with most recent)
Employment Dates (mo / yr)
Company Name
From:
Address
Salary
To:
Starting:
(city)
(street)
Position Held
Ending:
(state)
Supervisor’s Name
Phone
(
(zip)
May we contact?
)
-
Yes
No
Reason(s) for leaving:
Job Duties:
Employment Dates (mo / yr)
Company Name
From:
Address
Salary
To:
Starting:
(city)
(street)
Position Held
Ending:
(state)
Supervisor’s Name
Phone
(
)
-
(zip)
May we contact?
Yes
No
Reason(s) for leaving:
Job Duties:
Employment Dates (mo / yr)
Company Name
From:
Address
Salary
To:
Starting:
(city)
(street)
Position Held
Supervisor’s Name
Ending:
(state)
Phone
(
(zip)
May we contact?
)
-
Yes
No
Reason(s) for leaving:
Job Duties:
OTHER
Please mention any other skills, qualifications or experiences you feel are pertinent to the career/position you seek, including computer
programs, equipment or special training received:
PLEASE READ BEFORE SIGNING: (If you have any questions regarding the following statements, please ask a Bank representative before signing.)
In the event of my employment by the Bank, I will comply with all rules and regulations as set forth in the Bank’s policies/procedures and other
communications distributed to employees.
I authorize any of the above named references to furnish Inland Northwest Bank or its affiliates with any information concerning my education, employment
history, or any other matter related to my application for employment with the Bank. I hereby release those named references from all liability for any
damage whatsoever incurred in furnishing such information except that resulting from misrepresentation.
I understand that, if hired, employment with Inland Northwest Bank will be at-will and may be terminated by the Bank or me at any time for any reason. I
further understand that the at-will nature of my employment cannot be changed except by a formal written contract signed by the employee and the
President of the Bank, and that all terms and conditions of employment are subject to change without notice at any time.
I attest that the information provided in this application is true and accurate to the best of my knowledge, and that I have withheld nothing that would, if
disclosed, affect this application unfavorably. I understand that any misrepresentation or omission may result in the refusal to hire me, or termination of
employment if discovered after hire.
By signing below, I hereby acknowledge that I have read and understand the above statements.
Signature of Applicant
For Internal Use Only -
Date
Received:
Posting #:
Action Taken:
(Rev 12/07)
Fair Credit Reporting Act Disclosure and Authorization
As part of the hiring process, and at various times throughout the employment relationship (if
you are hired), Inland Northwest Bank (INB) may wish to obtain and review a "Consumer
Report" about you from a "Consumer Reporting Agency." The Fair Credit Reporting Act (FCRA)
defines these terms, which apply to you, a "consumer" with rights under the FCRA. See also
RCW 19.182.020.
A Consumer Reporting Agency is a person or business that, for monetary fees, dues or on a
cooperative, non-profit basis, regularly assembles or evaluates consumer credit information or
other information on consumers for the purpose of furnishing Consumer Reports to third parties,
such as INB.
A Consumer Report is any written, oral or other communication of any information by a
Consumer Reporting Agency bearing on a consumer’s credit worthiness, credit standing, credit
capacity, character, general reputation, personal characteristics or mode of living, which is used
or collected for the purpose of serving as a factor in establishing the consumer's eligibility for
employment purposes.
If INB obtains a Consumer Report about you, and if INB considers any information in the
Consumer Report when making an employment-related decision that directly and adversely
affects you, you will be provided with a copy of the Consumer Report before the decision is
finalized. You may also discuss your rights under the FCRA directly with the Consumer
Financial Protection Bureau (1700 G Street N.W., Washington, DC 20006).
By your signature below, you hereby authorize Inland Northwest Bank to obtain a Consumer
Report about you in order to consider you for employment. Your signature also authorizes us to
obtain a Consumer Report at any time during your possible employment with Inland Northwest
Bank.
Applicant’s Signature
Print Name
Date
Social Security Number
Address
City, State, Zip
(Rev 1/2014)
Procurement of Background Reports
Disclosure & Authorization
In connection with my application for employment at Inland Northwest Bank, I understand that
investigative background inquiries may be made on me which may include criminal convictions, motor
vehicle history, confirmation of previous employment and education, drug testing, and other reports.
These reports may include information addressing my character, work habits, performance, and
experience along with reasons for termination of employment from previous employers. Further, I
understand that you will be requesting information from various Federal, State, and other agencies
which maintain records concerning my past activities relating to my driving, criminal, civil and other
experiences. If I include a current employer for verification, I may jeopardize my position within that
company. I authorize without reservation, any party or agency contacted to furnish the abovementioned information and release all parties involved from any liability and responsibility for doing so.
I hereby consent to obtaining the above information. This authorization and consent shall be valid in
original, fax or copy form. I further authorize ongoing procurement of the above-mentioned tests and
reports at any time during my employment.
Applicant Signature:
Date:
Note: Upon receipt of a conviction record, you will be notified of such receipt within 30 days after the receipt of the record. INB will make the record
available to you for examination.
(please print clearly)
Name:
Maiden/AKA:
First
Middle
Last
Position Applied For:
Social Security #:
*Date of Birth:
Current Address:
City:
County:
State:
Zip:
Previous Address:
City:
How Long:
to
County:
State:
Zip:
How Long:
to
Name as it appears on your driver’s license:
Driver’s License #:
Issuing State:
*Response is voluntary; you need not respond to have your application considered. However, without this information, we may be unable to
distinguish you from another in the event we discover adverse information during our background investigation.
(Rev 12/07)
421 W. Riverside Ave, Ste 113
Spokane, WA 99201
509.456.8888 • www.inb.com
Affirmative Action Form –
Voluntary Applicant Identification
Federal Affirmative Action rules require us to maintain detailed data on applicants, hires, and other employment actions by race and sex; to
continually monitor our process and to ensure we provide equal opportunity; and to conduct good faith outreach and recruiting efforts to
attract and retain ethnic minorities, women and disabled veterans and veterans of the Vietnam era, and other persons with disabilities.
We invite you to VOLUNTARILY identify yourself in the categories below, now or at anytime in the future, to take advantage of our
program. You are not required to provide this information. If you choose to decline, it will not subject you to any adverse treatment. This
form is immediately separated from your selection file and will be kept confidential and only used in ways consistent with the law.
Name:
Phone:
Gender:
Position Applied For:
Male
Female
Age:
I do not wish to self-identify
ETHNIC GROUP
(Choose ONLY ONE ethnic group with which you most closely identify.)
White – Not of Hispanic origin. A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black or African American – Not of Hispanic origin. A person having origins in any of the Black racial groups of Africa.
Hispanic or Latino – A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin,
regardless of race.
Asian – 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.
Native Hawaiian or Other Pacific Islander – A person having origins in any of the peoples of Hawaii, Guam, Samoa or other
Pacific Islands.
American Indian or Alaskan Native – A person having origins in any of the original peoples of North America, and who maintains
cultural identification through tribal affiliations or community recognition.
Two or More Races – All persons who identify with more than one of the above six races.
DISABILITY & VETERAN STATUS
(Select all that apply.)
Disabled Individual – Any person who (a) has a physical or mental impairment which substantially limits one or more of such
person’s major life activities, (b) has a record of such impairment, or (c) is regarded as having such impairment.
Disabled Veteran – Includes (a) a veteran who is entitled to compensation under laws administered by the Veteran’s
Administration, or (b) a person who was discharged from active duty because of a service disability.
Other Protected Veteran – Veteran who served on active duty in the U.S. military during a war or in a campaign or expedition for
which a campaign badge is awarded.
Armed Forced Service Medal Veteran – A veteran who, while serving on active duty in the U.S. military, ground, naval or air
service, participated in a U.S. military operation for which an Armed Forces service medal was awarded pursuant to Executive
Order 12985 (61 FR 1209, 3 CFR, 1996 Comp., p. 159).
Recently Separated Veteran – A 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.
HOW DID YOU LEARN ABOUT THIS POSITION?
Newspaper: (select one)
INB Website
Spokesman-Review
Veterans Administration
CDA Press
Employee Referral
Other Newspaper:
Name:
Washington Job Service
Other:
Idaho Job Service
Signature of Applicant
Date
Pre-Employment Basics
The maintenance of extremely high standards of honesty, integrity, impartiality, and
conduct is essential to assure the proper performance of Inland Northwest Bank's
business and to maintain the public's trust. The preservation of that trust and the
Bank's reputation requires close observance of expected standards of conduct on the
part of the Bank's employees. Inland Northwest Bank expects that all employees
understand it is the employee's responsibility as set forth in our Code of Ethics to
comply with these standards.
The following list contains some of the basic requirements for one to be considered for
employment at INB. Please read through these items carefully. If you do not feel that
you can comply with each of these items, you should probably consider applying
elsewhere for employment. You should discuss this with the supervisor if you are
selected for an interview. These are non-negotiable. If you become an employee of the
Bank, failure to comply with these or any of Inland Northwest Bank’s polices will result in
disciplinary action which may include termination of employment.
1. You will be required to have reliable year-round transportation at all times.
2. You will be required to conduct yourself with exemplary work ethics. Tardiness,
excessive absences, or any unbecoming conduct which brings a negative
reflection on the Bank will not be tolerated.
3. You will be required to comply with the Bank's Dress Code, which requires very
professional attire. If you would like a copy of that policy, you may request one.
4. You will be required to comply with the Bank's standards of confidentiality and
privacy, and will be expected to never discuss matters of a confidential nature
relating to the Bank's affairs or its customers. You will be required to accept the
principle that the welfare of the Bank depends upon the conduct and honesty of
staff members and the trust and confidence of the public, understanding that our
customers rightly expect honesty, security, privacy and confidentiality concerning
their accounts and Bank business.
5. You will be expected to conduct yourself professionally, with a positive manner
and attitude at all times. Everyone is to be treated with dignity and respect at all
times.
6. Employees are expected to uphold the highest level of honesty and integrity.
Dishonesty of any kind will not be tolerated.
7. Because INB intends to provide a healthy work environment, free of the harmful
effect of drugs or substance abuse, you will be required to comply with our Drug
& Alcohol Policy.
(Rev 12/07)