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Personal

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Current Address
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Security
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Have you passed your 18th birthday? *
Are you a citizen of the U.S. or do you have a valid Green Card? *
Have you ever been convicted of, or pled guilty or 'no contest' to a felony or misdemeanor? *
Do you have the ability, with or without reasonable accommodations, to work overtime or to travel if travel and/or overtime are required by the job for which you are applying? *
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Driver's License Information

Information

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Type *
Currently valid? *
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Employment Desired

Employment
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Desired Length of Employment (required)
Have you ever applied to our company before? *
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Have you ever worked for our company before? *
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Are you related to anyone that works at Republic Bank & Trust?
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If hired, do you expect to be working in any other business or job?
Are there any days or hours you would be unavailable or unwilling to work? *
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Capability/Reliability

Capability/Reliability

Would you be willing and able to perform all of the tasks required by the job you are applying for as described in the job description for the position? *
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If hired, will you abide by the safety rules of this company? *
Would you be willing and able to report to work on time every day on a regular and consistent basis? *
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Your Level of Education

Education

Do you have a high school diploma or your GED? *
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College 1
Dates
Did you graduate?
College 2
Dates
Did you graduate?
Trade School
Dates
Did you graduate?
Are you planning to pursue further studies?
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Work History

Work History

List names of employers in consecutive order with present or most recent employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give company name and include business references. Please give month and year. Please do not reference your resume.

Employer 1
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Address
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Dates
Salary
May we contact this employer?
Employer 2
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Address
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Dates
Salary
May we contact this employer?
Employer 3
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Address
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Dates
Salary
May we contact this employer?
Employer 4
Address
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Dates
Salary
May we contact this employer?
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Supplemental Employment

Supplemental Employment

Supplement 1
Supplement 2
Have you ever been fired, or asked to resign, from a job? *
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Special Skills

Do you type?
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Have you had any computer or word processing experience or training?
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References

References

Reference Contact 1
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Address
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Reference Contact 2
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Address
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Reference Contact 3
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Address
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(Optional section) Affirmative Action Form

Affirmative Action Form (optional)

It is the policy of Republic Bank and Trust to provide equal employment opportunities to all individuals based on job-related qualifications and ability to perform a job without regard to age, gender, sexual orientation, race, color, religion, creed, national origin, disability, veteran, or marital status, and to maintain a non-discriminatory environment free from intimidation, harassment or bias based upon these grounds. As an employer and federal contractor, we comply with government regulations and affirmative action responsibilities. In order to help us comply with government record keeping, reporting and other legal requirements, we request that you complete this affirmative action survey. The completion of this form is voluntary. This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment. Government Agencies require periodic reports on the gender, ethnicity, disability, and veteran status of applications. This data is for analysis and affirmative action only. This information is voluntary and will be treated confidentially. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment.

Gender:
Race (optional) Select one of the following:
Confirmations
(Required) Certification Statement

Certification Statement (Required)

I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge. I agree that, if I am employed, I will abide by all the policies and regulations of the Bank. I further understand that no one in the Bank is authorized to enter into any written or verbal employment contracts with me for any definite period of time without express written consent of the president of the Bank. I also understand that employment with Republic Bank & Trust is "at-will" and may be terminated by myself or by the Bank at any time for any reason or no reason at all, with or without prior notice. *

(Required) Clothing Guidelines

Click Here to view Republic's "Clothing Guidelines & Personal Appearance" document.

I have read the attached (above) "Clothing Guidelines & Personal Appearance" document *

After you've read through the above "Certification Statement," and clicked agree, and agreed to the "Clothing Guidelines" by choosing yes, please click the Submit button below to finalize your application.

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