687-20840 - Personal Banker

Feb 2, 2024

Personal Information

The forms below include important information and policies required to start your employment process. These forms must be completed prior to
your start date. If you have any questions while completing this information, please contact the main Human Resources office at 254-554-4392.

Please verify the personal information that you provided in your employment application. Your name must appear exactly as it is on your Social Security
Card.

If your mailing address is a P. O. Box, you must also provide a physical address.

Please select a shirt size for your Logo Uniform Shirt. The shirts run true to size and you have the option of Men/Women XSmall - 5XL.

The company will provide each employee with a name badge. This badge will include your legal first and last name.
First Name : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Leah
Middle Name : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Monique
Last Name : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chavez
Preferred First Name :
If differs from legal first name.
Mailing Address : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7622 crestway Ridge
Mailing Address 2 : .
.....................................................
City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . San Antonio
State: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Texas
Zip Code: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78245
Physical Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If mailing address is P.O. box, please also provide physical address.
Physical Address 2: .
.....................................................
State: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Zip Code: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Daytime Phone : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (210) 710-3361
Secondary Phone : .
.....................................................
Home E-mail Address : . leahparker857@gmail.com
.....................................................
Date of Birth : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/18/1987
Social Security : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
627-14-0552
(please do not use dashes - ex 999999999)
Additional Languages Spoken : . English
.....................................................
Shirt Size: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Women's-XL
Please remember to save any changes prior to exiting this form. Upon employment date, you will be able to make any personal information changes,
such as address updates, W4 exemption status, education, and direct deposit information, through Employee Self Service.
Emergency Contacts
To add additional emergency contacts, click the "Add Emergency Contact" button below.
The "Remove Last Emergency Contact" will delete all entries for the last emergency contact that you have entered.
Please do not use any special characters such as tilde's, hyphens, apostrophes, etc.

Emergency Contacts

Emergency Contact 1
Primary Contact? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Same Address as Employee? . Yes
.....................................................
First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marylou
Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Parker
Address 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Zip/Postal Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2102500448
Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mother

Please do not use any special characters such as tilde's, hyphens, apostrophes, etc.
Direct Deposit

Direct Deposit

Please verify that your Direct Deposit information is correct. Your routing number will be located at the bottom of your check or deposit slip and will be
9 digits, the account number will be located at the bottom of your check either preceding or following the routing number. *Any changes to Direct
Deposit information, including bank account changes and cancellations, must be made through the MyADP portal no later than three days prior to the
effective date of the change.
Direct Deposit is a benefit that we offer to all employees, however, you are not required to select this option.

If you are interested in an Employee Bank Account with us, information will be given to you to open an account on your first day of employment.
** = Conditionally Required

Would you like to enroll in direct deposit? . No

.....................................................

Direct Deposit 1
To add additional direct deposit accounts, click the "Add Direct Deposit" button below.
The "Remove Last Direct Deposit" will delete all entries for the last direct deposit account that you have entered.
Account Type** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Full Deposit** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Routing Number** .
.....................................................
Account Number** .
.....................................................
If no is selected for full deposit, enter amount for partial deposit.** . $0.00
.....................................................

I authorize my employer and the financial institution indicated below to deposit my net pay automatically each payday. If monies to which I am not entitled are deposited in my account, I
authorize my employer to direct the financial institution to return said funds. This authority will remain in effect until I have cancelled it in writing.

Electronic signature, please sign below:

Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Leah Chavez

Self Identification

Self Identification

Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hispanic or Latino

Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Female
Military Dependent Status .
.....................................................

Electronic signature, please sign below:

Signature:

The information will be kept confidential and will only be used in accordance
with the provisions of applicable laws, executive orders and regulations, Leah Chavez
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.
Date : February 2, 2024
Employee Acknowledgement Form BCP Awareness Training

EMPLOYEE ACKNOWLEDGEMENT FORM

BCP AWARENESS TRAINING
Form Last Revised: 05/20/05

I understand & acknowledge the following:

1) Completing this form is mandatory for all employees on an annual basis.

2) The Company has comprehensive Business Continuity Plans in place to assure my safety and to assure that the Company will be
able to restore customer services that may be disrupted by natural or manmade disasters.

3) Should a Company facility that I am working in be hit by a disaster,

If I am NOT a senior management employee, I know that my responsibility is to first assure my personal safety and then refer
to my immediate supervisor for guidance concerning what to do in response to the disaster.

If I am a senior management employee, I know that my responsibility is to first assure my personal safety and the safety of my
employees and then refer the company's Business Continuity Plan for guidance concerning what to do in response to the
disaster.

I have read an understand the above. I understand Human Resources will maintain this form in my permanent personnel file.

Employees Printed Name: Leah Chavez Leah Chavez

Accepted
Date: February 2, 2024

Employee ID#: _________________________

Department: FCB FM 78 HEB-687

Name of your Supervisor: Azucena Grunsten

Please sign your legal name as it shows on your application.

(Leah Chavez)

I authorize my Electronic Signature.

Work Hours and Assignments

FIRST COMMUNITY BANCSHARES FIRST HEROES NATIONAL BANK

FIRST NATIONAL BANK TEXAS FIRST COMMUNITY SERVICES
Corporate Policies and Procedures
_____________________________________________________________________________________________________________
Subject: Work Hours and Assignments

Policy Number: HR-103 Origination Date: 03-01-2005

Board Approval Date: 01-23-2019 Revision Date: 01-01-2019
_____________________________________________________________________________________________________________

PURPOSE

To establish company expectations regarding employee work hours and assignments and to ensure compliance with the Fair Labor Standards Act
(FLSA).

DEFINITIONS

Exempt Employees: Exempt employees are paid a base salary for performance of their duties as opposed to payment or actual time worked.
Accordingly, they are not eligible for overtime pay.

Non-Exempt Employees: Non-exempt employees are paid for all hours worked. Overtime is paid at 1 ½ times the regular hourly rate of pay for
work over 40 hours in a work week.

POLICY

Work Assignments: To ensure that customers are provided the best possible service, work assignments are based on matching employee qualifications
with customer and FCBI needs. From time to time it may be necessary to reassign employees to a different center, department, location, or job
responsibility. Such assignments will be made at the discretion of an employee's supervisor or manager.

Work Schedules: FCBI reserves the right to set work schedules as deemed necessary to maintain quality customer service and efficient day-to-day
operations. This may require altering starting and ending times and/or the total hours an employee is scheduled to work. As with work assignments,
work hours are set by an employee's supervisor or manager.

Overtime: From time to time additional hours (overtime) may need to be worked to meet customer deadlines or other company needs. Prior to working
overtime, non-exempt employees must receive approval from their department manager. Individuals working unauthorized overtime will be subject to
disciplinary action up to and including separation of employment.

Meal Periods: Each day, employees working at least five hours may be allowed 30 minutes unpaid time off for a meal period. Meal periods are not
required by law and will be coordinated by each supervisor. Employees are expected to return to work promptly at the end of their meal period. Failure
to do so is considered an instance of tardiness.
Subject: Work Hours and Assignments

Breaks: Breaks are not required by federal or state law but may be given mid-morning and mid-afternoon; however, they will be coordinated and given
at the discretion of each supervisor. Breaks are provided so that employees can attend to personal matters such as getting a snack or something to
drink (refreshment), using the restroom, smoking in designated areas, and making personal telephone calls.

PROCEDURES

Federal law (The Fair Labor Standards Act, FLSA) and FCBI policy require all nonexempt employees to record hours worked.

Each supervisor or manager is responsible for establishing the work schedule of the employees under his or her supervision.

An employee who has special scheduling needs should discuss them with his or her supervisor. When possible, supervisors may attempt to
accommodate special scheduling needs; however, they retain the right to establish the final schedule that an employee will be required to work.

Reporting of Time

All non-exempt employees are to record all of their hours worked on a weekly electronic time card using eTime located on the Intranet.
Employees must record their beginning and end of their shift as well as any meal periods or extended breaks. Time reported should also
include all time worked for preparatory and closing procedures throughout the work day. Necessary and approved adjustments or edits
should be made in accordance with eTime procedures.

All hours must be accounted for on the employee's electronic time card. Absences should be reported on a "Request for Absence" form and
faxed to the Payroll Department no later than Monday of the following week.

Falsifying time cards is a serious policy violation and will not be tolerated. Under no circumstances should non-exempt employees perform
any work for the company without reporting it on their time card. This practice is strictly prohibited and will result in corrective action up to
and including separation in any instance.

Sharing personal eTime login information is prohibited and may result in corrective action up to and including separation from
employment.

Employees must approve and/or make corrections to their electronic time card by the end of the day Monday for the previous work week.
Managers must review their department's time cards by using the Time Detail and Timecard Audit Trail Reports. Managers must notify the
Payroll Department of any corrections needed after the Monday deadline.
FIRST COMMUNITY BANCSHARES FIRST HEROES NATIONAL BANK
FIRST NATIONAL BANK TEXAS FIRST COMMUNITY SERVICES
Corporate Policies and Procedures

_______________________________________________________________________________________________________
Subject: Work Hours and Assignments

Policy Number: HR-103 Origination Date: 03-01-2005

Board Approval Date: 01-23-2019 Revision Date: 01-01-2019

_______________________________________________________________________________________________________

Time Card Accuracy

Each FCBI employee is responsible for the accuracy of his/her hours to be paid for each payroll period, as detailed on the employee's time card. In the
event that the employee submits a time card that is incorrect, and a payroll adjustment is needed, the payroll adjustment will not be made until the
following pay period.

FCBI's work week extends from Sunday through Saturday. Exempt employees are paid on the 15th and last day of each month. Non-exempt employees
are paid bi-weekly according to the pay day weeks' schedule.

Prior to submitting time cards for the current pay period, each employee should review the total hours to be paid. Any discrepancy should be brought
to the attention of the Manager for resolution.

Please carefully read the following statement, prior to signing below. If you have any questions, ask for clarification from your Manager or you may
contact your regional Human Resource Department.

When you record your signature, you are acknowledging your responsibility for the accuracy of your time cards.

I hereby assume responsibility for late payment of any wages due me from FCBI if, in fact, I fail to review my time card for accuracy or submit my time
card with any errors (which will be corrected at a later time via manual request through the Payroll Department).

I realize that I am responsible for finalizing my time card and verifying its accuracy, prior to Monday of the following week.

I agree to indemnify and hold harmless FCBI against any liability for late payment of wages due to my failure to comply with the aforementioned
responsibilities.

Please sign your legal name as it shows on your application. Leah Chavez
Accepted
(Leah Chavez)

I authorize my Electronic Signature.

February 2, 2024
Publicity Release

Publicity Release
In exchange for my employment or continued employment, which is good and valid consideration for my grant of permission herein, I hereby grant
permission to First Community Bancshares, Inc. or one of its entities i.e., First National Bank Texas; First Convenience Bank; Fort Hood National Bank;
First Community Mortgage; or First Community Services (collectively, the "Company") the right to photograph me and/or use my picture, silhouette and
other reproductions of my physical likeness (as the same may appear in any still camera photograph, video or other electronic imaging and/or motion
picture film) and any sound recordings of my voice ("Likeness"), in the Company's advertising, educational and promotional materials used in
connection with its business. I understand and agree that my Likeness may be used in any form of media that currently exists or which may exist in the
future.

By signing below, I acknowledge and agree that the Company, its directors, officers, employees, agents, assigns and controlled and controlling persons
are further released from any and all liabilities, obligations and/or claims arising out of or in connection with the use of my Likeness as set forth
herein. This release shall remain in full force and effect until the Company's receipt of a written revocation by me or my authorized representative.

I hereby certify and represent that I have read the foregoing and fully understand the meaning and effect thereof.
Please sign your legal name as it shows on your application. Leah Chavez
Accepted
(Leah Chavez)

I authorize my Electronic Signature.

February 2, 2024
Disclosure of Criminal Records

FIRST NATIONAL BANK TEXAS

FIRST HEROES NATIONAL BANK
_______________________________________________________________________________________________________
Subject: Disclosure of Criminal Records
Item Number: HR-1011 Origination Date: 01-2012
Board Approval Date: 01-25-2012 Revision Date: 01-2012
_______________________________________________________________________________________________________

PURPOSE
To define the requirement for employees to provide full disclosure of any arrests, convictions and/or entry into diversion programs such as probation
or deferred adjudication, while actively employed with First Community Bancshares, Inc. (FCBI) or its affiliated companies.

POLICY
During the course of active employment, all employees are required to immediately disclose the following to their direct manager: any arrest,
indictment, conviction, and/or probation or deferred adjudication received in relation to any type of criminal offense. Any disciplinary action taken as
the result of a criminal record will be in accordance with FDIC employment regulations, and FCBI standards of conduct and code of ethics.

Manager Responsibility
Branch/department managers are responsible for reporting employee-disclosed criminal record information to their Regional Human Resources
department.

Employment Action
Any employee who fails to disclose a criminal offense at the time of arrest or indictment;or an employee who attempts to withhold or falsify
information pertaining to a criminal record, will be subject to disciplinary action up to and including termination of employment. FCBI reserves the
right to take legal action against employees who engage in prohibited or illegal conduct.
This HR Policy manual does not create an employment contract between FCBI and the employee. FCBI reserves the right to change, add, eliminate, or
modify any of these documents at its discretion, with or without notice.
POLICY ACKNOWLEDGEMENT
Employee Name: Leah Chavez

Employee ID #:

I have read and understand the contents of FCBI's policy and procedures for:

Disclosure of Criminal Records

I underdstand that failure to comply with the policy could result in disciplinary action up to and including termination of employment. I also
understand that during the course of my employment with FCBI, I am required to immediately disclose any arrest, indictment, conviction and/or
probation or deferred adjudication received in relation to any type of criminal offense.

Please sign your legal name as it shows on your application. Leah Chavez
Accepted
(Leah Chavez)

I authorize my Electronic Signature.

February 2, 2024
Job Description Acknowledgement

Job Description Acknowledgement Form

Job Title: Personal Banker-PBF

Department: FCB FM 78 HEB-687
FLSA Status: Non-Exempt

Minimum Qualifications and Education Required:

* Six months of work experience in a retail or customer service environment preferred
* Must be able to get along with co-workers and work effectively in a team environment.
* Must be able to work a flexible schedule including evenings, weekends, and holidays.
* Schedules are prepared based on business need and subject to change at any time.
* High school diploma, high school equivalency or currently attending high school
* At least 18 years of age
* Must successfully pass background investigation according to company policy

External/Primary Job Duties:

Under immediate direction, provides exceptional customer service, involving receipt and payment of cash, while working in a high volume, sales
environment.
* Follow the established policies in accordance with the bank and the supervisor's direction
* Accountable for the personal achievement of monthly new account production as assigned by upper management
* Process deposits and pay out funds in accordance with bank procedures, to record all transactions accurately and balance each day's operations
* Receive cash and checks for deposit, verify amounts, and look for check endorsements
* Examine cash carefully to guard against acceptance of counterfeit checks and identification
* Enter transactions into computer and issue customer receipts
* Sell and prepare money orders, cashiers checks, bank-to-bank wires, savings bonds, travelers' checks and certificates of deposit
* Process western union wires and cash advances
* Cross-sell bank services and products
* Provide bank services to a diverse customer base, including a large Spanish speaking population
* Approval limits will be based upon level of authority
* Perform other tasks requested by supervisors as they relate to the bank and its functions

Environmental and Physical Requirements:

* Required to stand or walk for extended periods of time dependent upon branch location
* Ability to work in a high volume, stressful and noisy environment
* Operate a computer and other office machinery
* Ability to lift up to 25 lbs

FCBI is an equal opportunity employer.

The above statements are intended to describe the general nature and level of the work being performed by the person(s) assigned to this position.
They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of the incumbent.
I, Leah Chavez, have reviewed my current Job Description and fully understand my job requirements and responsibilities.

I understand that I will be held accountable for the completion of the job duties and objectives assigned to me. Failure to meet these objectives may
result in re-training, counseling, and/or desciplinary action up to and including separation of employment.
Please sign your Legal Name as it shows on your Leah Chavez
Accepted
application. Leah Chavez

I authorize my Electronic Signature.

Date: February 2, 2024

Phishing & Related Threat Policy

FIRST COMMUNITY BANCSHARES

Corporate Policy Board Approval Date: 10-25-2023

IT 109: Phishing & Related Threat Policy

_________________________________________________________________________________________________________

PURPOSE

Phishing is the primary cause of most cyber breaches. Most successful attacks against a company start with a phishing, vishing, smishing or squishing
attempt and can result in service impacts, ransom attacks, or breach of customer and corporate information.

SCOPE

This policy applies to all FCBI employees and contractors accessing FCBI systems, network and information, whether from FCBI devices or personal
device.

DEFINITIONS

Phishing, is an email-borne attack that attempts to get employees and your email software to do something malicious. Many attacks are an attempt to
obtain confidential information (passwords, financial information, etc.) from an unsuspecting person through email with a link or attachment that looks
like its from a legitimate source and requests the recipient to take action.

Smishing is a text/SMS attack that attempts to get the recipient to take an action via a link or response to text. These attacks are used to collect
credentials, personal/private information or to install malware on your phone.

Quishing is the use of a QR code in a phishing email. The QR code directs the recipient to a malicious website to collect credentials, personal/private
information, or to install malware on your computer.

Vishing is a voice based call from a threat actor that attempts to collect information or get the recipient to take an action. The action typically involves
the recipient accessing a malicious site and granting the threat actor remote access to your computer to install malware or ransomware on your
computer.

STATEMENT OF POLICY

IT Management will implement solutions that will help to identify phishing, vishing, smishing and quishing threats or attacks and will quarantine such
communication prior to delivery to the greatest extent possible. Techniques used by threat actors will change and such solutions may not always
provide complete protection from attacks. Employees of FCBI with external email access will be required to complete annual phishing, vishing,
smishing and quishing detection training and be subject to monthly phishing tests. The results of these tests will be provided to IT Steering and Board
of Directors.
FIRST COMMUNITY BANCSHARES
Corporate Policy Board Approval Date: 10-25-2023

IT 109: Phishing & Related Threat Policy

_________________________________________________________________________________________________

Disciplinary Actions

Employees that fail a periodic phishing or other threat testing within a 12 month rolling period will be subject to progressive disciplinary actions as
follows:

1. The first occurance of a test failure will result in a written warning notice administered by the employee's responsible EVP or SVP and will require
retraining.

2. The second occurance of a test failure will result in a final warning notice in addition to email restrictions where external email access is removed
subject to reinstatement by the CEO or his/her designee.

3. The third occurrrence of a test failure may result in further disciplinary action up to and including termination.

Employees that fail to identify an actual phishing or other threat and activate a malicious threat/attack as a result, will be suject to all of the disciplinary
measures outlined above up to and including termination.

Please sign your legal name as it shows on your application. Leah Chavez
Accepted
(Leah Chavez)

I authorize my Electronic Signature.

February 2, 2024
Benefit Acknowledgement

Benefit Enrollment Acknowledgement Form

I have received and/or been made aware of:

Regular employees working at least thirty (30) hours per week are eligible for benefits after 90 days of service.

As a Part Time 30 or Full Time 40 hour employee, I understand an Enrollment Event on MyADP is currently open for me. This constitutes an offer
of coverage.

As a Part Time 20 hour employee, I understand that I am not currently eligible to enroll in insurance benefits. In the event I become eligible for
insurance benefits, I will be notified of my offer of coverage.

Patient Protection and Affordability Care Act (PPACA) rules of eligibility may not allow me to drop health coverage if I change my employment
status from full to part-time. And for additional information regarding PPACA eligibility, go to the Summary Plan Description(s).

Instructions on how to access Self Service enrollment including how to determine my log on ID and password.

Instructions describing how to access and view electronic copies of the FCBI Plan, Summary Plan Descriptions (SPD), Summary of Benefits and
Coverage (SBC), and Uniform Glossary. The SPD and SBC describe important information about your benefits. The Uniform Glossary includes
commonly used definitions of health coverage and medical terminology.

My right to request and obtain a paper version of the SPDs, SBCs, and Uniform Glossary at no charge from the FCBI Benefit Department.

For password assistance contact: humanresources@1stnb.com, audrey.fischer@1stnb.com, becky.williams@1stnb.com or call 254-554-0812.

Once elections are completed, I must confirm my elections. After confirming my elections, I must print a copy of my confirmation from the
Health and Welfare enrollment site as proof of my insurance elections.

Contact information for the FCBI Benefit Department including the address, P.O. Box 937, Killeen, TX 76540, and the toll-free number is
844-393-6940.

Printed Name: Leah Chavez Leah Chavez

Accepted
RC/EIN: FCB FM 78 HEB-687

Please sign your legal name as it shows on your application.

(Leah Chavez)

I authorize my Electronic Signature.

February 2, 2024
Electronic Signature

Electronic Signature

I understand that any false answers, statements or implications by me in this application or other required documents shall be considered sufficient
cause for denial of employment or discharge.
Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment
contract between FCBI and myself for either employment or the providing of any benefit. No promises of employment have been made to me and I
understand that no such promise or guarantee is binding upon FCBI unless made in writing. If an employment relationship is established, I understand
that I have the right to terminate my employment at any time for any reason and that FCBI retains a similar right. My acknowledgement below indicates
I have fully read and understand all expressed conditions and terms of this application.

ELECTRONIC SIGNATURE: Please type your full legal name as it is listed in your application (Leah Monique Chavez ): I testify that this statement is true to the
best of my knowledge:
I authorize my Electronic Signature . Leah Chavez
..................................................... Accepted
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Feb 2, 2024 02:54 pm
(will auto populate once form is submitted)