Job Application

"*" indicates required fields

Step 1 of 7 - Applicant Information

14%

What position are you applying for?*

Customer Service Representative

Insurance Agent

Application Date*

Month

Day

Year

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Are you 16 Years or Older?

Yes

If not, can you submit a work permit?

Yes

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

How did you hear about this position you are applying for?

If hired, when will you be available to start?

Salary Desired*

Are you employed now?

Yes

If so, may we inquire of your present employer?

Yes

Have you ever applied to Jones Bank before?*

Yes

If yes, Where & When?*

Have you ever worked at Jones Bank before?*

Yes

If yes, Where & When?*

What days and hours are you willing to work?*

Can you work overtime if required?*

High School Name and Address

High School Years Completed

High School Diploma

Yes

College Name and Address

College Course of Study and Year(s) Completed

College Diploma/Degree

Trade, Business or Correspondence School Name and Address

Course of Study and Year(s) Completed

Diploma/Degree

Describe any job related specialized training, apprenticeship, skills and extra-curricular activities:

Please do not include any information that would reveal a protected class status

List any job-related professional or technical organizations to which you belong:

Please do not include any information that would reveal a protected class status

Former Employers

List the last three employers, starting with the most recent one first.

Name of Present or Last Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Starting Date

Leaving Date

Starting Base Salary

Final Base Salary

Amount of Bonus

May we contact your supervisor?

Yes

Name of Supervisor

Supervisor's Title

Phone

Description of work:

Reason for leaving:

Name of Previous Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Starting Date

Leaving Date

Starting Base Salary

Final Base Salary

Amount of Bonus

May we contact your supervisor?

Yes

Name of Supervisor

Supervisor's Title

Phone

Description of work:

Reason for leaving:

Name of Previous Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Starting Date

Leaving Date

Starting Base Salary

Final Base Salary

Amount of Bonus

May we contact your supervisor?

Yes

Name of Supervisor

Supervisor's Title

Phone

Description of work:

Reason for leaving:

Specialized Skills (Please check all that apply)

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Outlook

Fiserv

LaserPro

Moody's Analytics

10-Key

Desktop Publishing

Other

Other Specialized Skills

Reference 1 Name

First Last

Address

Years Acquainted & Phone Number

Reference 2 Name

First Last

Address

Years Acquainted & Phone Number

Reference 3 Name

First Last

Address

Years Acquainted & Phone Number

Have you been convicted of a felony or (within the last five years) a misdemeanor which resulted in imprisonment?

Note: The existence of a criminal record does not create an automatic bar to employment.

Yes

If Yes, please explain:

Can you meet the job requirements of the position for which you applied with or without accommodation?

Yes

If No, please explain:

Can you meet the work schedule or attendance requirements of the job?

Yes

If No, please explain:

Can you if employed submit verification of your legal right to work in the United States?

Yes

Please send your resume to: [email protected].

APPLICANT'S STATEMENT

I certify that the facts contained in this application and any accompanying resume are true and complete to the best of my knowledge. I understand that any falsification, omission, misrepresentation or concealment of information on this application or resume may be sufficient grounds for disqualification from further consideration for hire or immediate discharge and that the company shall not be liable in any respect if my employment is so denied or terminated.

I authorize investigation and verification of all statements contained herein and the references and former employers and employees to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise to include credit history, education, employment verification, personal references and criminal records. I release the company from all liability for any damage that may result from receiving and/or using such information.

I hereby understand and acknowledge that, any employment relationship with this organization is of an "at will" nature, which means that the employee may resign at any time and the Employer may discharge Employee at any time with or without cause or notice. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I also understand that this application and any employee manuals or handbooks that may be distributed to me shall not be construed or relied upon as a contract.

Terms*

Yes, I agree to the terms above.

Date*

Month

Day

Year

Our company provides goods and services to government entities through a variety of business relationships. To fulfill the obligations of these types of contracts require, we need to collect, maintain and occasionally report information related to employees.

At this time, we are asking you to help us meet our obligations by completing the forms and information listed on the following pages. Please note that the information will only be used in accordance with the provisions of applicable laws, executive orders, and regulations. Providing this information is voluntary and refusal to so will not result in any adverse treatment. The information you provide will be held in strict confidence except that:

Necessary management and supervisory personnel may be informed to ensure proper placement and to provide reasonable job accommodations;
First aid and safety personnel may be informed to the extent appropriate, if the condition might require emergency treatment; and
Government officials investigating affirmative action program compliance may have access to reported information.

Thank you for your cooperation in this important initiative.

Gender

Female

Male

Ethnicity and Race: Check ONE box from the list below

Hispanic or Latino - A person of Cuba, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless or 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 Alaskan 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.

Information on Individuals with Disabilities & Covered Veterans

Disabled Veteran: (1) 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 (2) a person who was discharged or released from active duty because of a service-connected disability

Other Protected Veteran: 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 assistance making this determination, contact Human Resources.)

Armed Forces Service Medal Veteran: 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. (For assistance making this determination, contact Human Resources.)

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.

I am a protected veteran, but I choose not to self-identify the classification to which I belong.

I am NOT a protected veteran.

I do not wish to provide the information requested.

(Check all applicable boxes)

If you are a disabled veteran, you may choose to use the space below to tell us about:

Any special method, skills, and procedures which qualify you for positions within Jones National Bank & Trust Company so that you can be considered for any positions of that kind, and
The reasonable accommodations which we could make which would enable you to preform the job properly and safely, including special equipment or other accommodations.

Explanation of skills and reasonable accommodations

Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. if you want to learn more about this law or this form, visit the US Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability.

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes
Disfigurement, for example disfigurement caused by burns, wounds, accidents or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Chron's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSDy
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
Nervous system condition, for example, migraine headaches, Parkinson's disease or Multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury

Please check one of the boxes below:

Yes, I have a disability, or have had one in the past

No, I do not have a disability and have not had one in the past

I do not want to answer

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