Application for Employment First Kentucky Bank

All applicants will be considered for employment at First Kentucky Bank without regard to race, color, religion, sex, national origin, citizenship, age, disability, veteran status, or any other legally protected status.

Name*

First Last

Home Phone

Cell Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Position applying for*

Email*

Special skills or training: (computer programs, languages, etc.) beneficial to position:*

Would you accept full-time position?*

Yes
No

Would you accept part-time position?*

Yes
No

Date you would be available for work?*

Have you ever been a First Kentucky Bank employee?*

Yes
No

Year

Do you have a legal right to be employed in the U. S.?*

Yes (Proof required)
No

Are you of legal age to work?*

Yes
No

Educational Background

High School

Name and location*

Course of study*

Did you graduate?*

Yes
No

College

Name and location

Case of study

Did you graduate?

Yes
No

Degree

College

Name and location

Case of study

Did you graduate?

Yes
No

Degree

Previous Employers

List most recent employer first.

1. Company Name*

Phone*

Contact Name & Title*

Address*

Position*

Employed From*

Mo/Yr

To*

Mo/Yr

Reason for leaving*

Last salary at this position*

2. Company Name

Phone

Contact Name & Title

Address

Position

Employed From

Mo/Yr

To

Mo/Yr

Reason for leaving

Last salary at this position

3. Company Name

Phone

Contact Name & Title

Address

Position

Employed From

Mo/Yr

To

Mo/Yr

Reason for leaving

Last salary at this position

I CERTIFY THAT ALL THE FACTS AND INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I
UNDERSTAND THAT IF ANY FALSIFICATION, OMISSIONS, OR MISREPRESENTATION OF FACTS ON THIS APPLICATION ARE DISCOVERED MAY RESULT IN DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR HOW DISCOVERED.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE BANK’S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT
ANY TIME, AT EITHER MY OR THE BANK’S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY
EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE BANK. I
UNDERSTAND THAT NO BANK REPRESENTATIVE, OTHER THAN THE PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

I have read and certify the above section.

Would you like to fill out the Voluntary Information?

Yes
No

Applicant Voluntary Self-Id Form

AFFIRMATIVE ACTION VOLUNTARY INFORMATION: Our company is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite applicants to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. Completion of information below is voluntary.

Name

First Last

Are you Hispanic, Latino, or of Spanish Origin?

Yes
No
I prefer not to answer

What is your race? (check all that apply)

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
I prefer not to answer

What is your gender?

Male
Female
Prefer Not to Answer

Referral Source:

Walk-in
State Employment Office
Private Employment Agency
Employee
Relative
School
Advertisement-Source
Other

specify

If School, Advertisement-Source or Other please specify

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. 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.

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.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, 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.

A copy of the veterans' affirmative action plan is available upon request by contacting Nicole Sullivan, HR Director between 8:00 am and 4:00 pm Monday-Friday via email at nicole.sullivan@firstkentucky.com or in person at the HR Department.

Veteran

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

Voluntary Self-Identification of Disability

Form CC-305, OMB Control Number 1250-0005, Expires 1/31/2017

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. 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 identify as having a disability earlier.

How do I know if I have a disability?

Blindness
Autism
Bipolar disorder
Post-traumatic stress disorder {PTSD)
Deafness
Cerebral

Major Depression
Obsessive compulsive disorder palsy
Cancer
HIV/AIDS
Multiple sclerosis (MS)
Impairments requiring the use of a Wheelchair

Diabetes
Schizophrenia
Missing limbs or partially missing
Intellectual disability (previously called mental retardation)
Epilepsy
Muscular dystrophy

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

Reasonable Accommodation on 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.

i Section 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.

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Application for Employment

First Kentucky Bank Application for Employment

Educational Background

High School

College

College

Previous Employers

Applicant Voluntary Self-Id Form

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

How do I know if I have a disability?

Reasonable Accommodation on Notice