Prospective employees will receive

consideration without discrimination

based on race, creed, color, sex, age,
national origin, handicap, veteran status
or any condition prescribed by state or
local law.

Employment Application
PERSONAL Date

Last Name First Middle Home Telephone

Street Address Cellular Telephone

City, State, Zip Business Telephone

Position Desired Location Desired Social Security #

Apart from absence for religious observance, are you available for Will you work Pay Expected
full-time work?  Yes  No overtime if asked?
If “No,” what hours can you work? __________________  Yes  No

Are you currently attending school? Are you related to a current employee of Founders? E-mail Address
 Yes  No  Yes  No
If “Yes,” please attach school schedule. If “Yes,” please list name(s) and relationship(s):

Are you legally eligible for Have you ever applied for employment with us? When will you be available
employment in the United States?  Yes  No If “Yes,” Month & Year: to begin work?
 Yes  No Location:
Have you been convicted of any crimes in the past ten years, excluding misdemeanors and Have you ever been
summary offenses, which have not been annulled, expunged or sealed by a court? bonded?
 Yes  No If “Yes,” describe in full.  Yes  No
If “Yes,” with what employers?

Have you ever been discharged from a position?  Yes  No

Please note: A “Yes” answer will not necessarily result in you not being considered for employment.

Membership in professional and civic organizations (Exclude those which may disclose your race, color, religion, age or national
origin). Other special training or skills (languages, machine operation, etc.), special accomplishments or awards.

EDUCATION – Please complete in full.

Name & No. of Yrs Did You Degree or
School Course of Study
Location of School Completed Graduate? Diploma

Graduate  Yes  No

College  Yes  No

Business/Trade/Technical  Yes  No

High School  Yes  No

MILITARY Did you serve in the U.S. Armed Forces?

 Yes  No
If “Yes,” in what branch?

Describe any training received relevant to the position in which you are applying.

Form #153 11/12

EMPLOYMENT – Please complete in full.
Please give accurate, complete
full-time and part-time employment
record. Start with your present or
most recent employer.

Company Name Telephone

Address Employed – (State month and year)

From To
Name of Supervisor Pay – (Please check one)
Hourly Weekly Monthly Annually
Start Last
1 State Job Title and Describe Your Work Reason for Leaving

Company Name Telephone

Address Employed – (State month and year)

From To
Name of Supervisor Pay – (Please check one)
Hourly Weekly Monthly Annually
Start Last
2 State Job Title and Describe Your Work Reason for Leaving

Company Name Telephone

Address Employed – (State month and year)

From To
Name of Supervisor Pay – (Please check one)
Hourly Weekly Monthly Annually
Start Last
3 State Job Title and Describe Your Work Reason for Leaving

We may contact the employers listed above DO NOT CONTACT

unless you indicate those you do not want us to
contact. Employer Number (s) _____________________ Reason _________________________________

Please read and understand this statement before signing your application:
The information I provided in this Application for Employment is true. False, incomplete or misrepresented information will be sufficient cause for my application
to be rejected or, if discovered after I am employed, cause for immediate termination of my employment. I authorize the employer to obtain information
about me from previous employers, educational institutions, and any other parties to verify the accuracy of information in this application, a related
employment resume, or personal interview. I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking, and using
information to evaluate my employment request and all other persons who provide information for this purpose. This application will expire in 6-months. Unless
otherwise notified, I understand that my status as an applicant will end. I may reapply for employment in the future by completing a new application.
THIS APPLICATION IS NOT AN EMPLOYMENT AGREEMENT. IF I ACCEPT AN OFFER OF EMPLOYMENT I UNDERSTAND THE EMPLOYER MAY TERMINATE MY EMPLOYMENT
AT ANY TIME, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE. I UNDERSTAND THAT NO ONE, OTHER THAN AN EXECUTIVE OFFICER OF THE EMPLOYER, HAS
AUTHORITY TO ENTER INTO ANY EMPLOYMENT AGREEMENT WITH TERMS CONTRARY TO THE FOREGOING AND THEN ONLY IN WRITING SIGNED BY SUCH OFFICER.

I accept all terms and conditions in the above statement. ______________ ________________________________
Date Signature
 NOTIFICATION OF INVESTIGATION
AND
INFORMATION RELEASE AUTHORIZATION

NOTICE

This is to inform you that as part of our procedure for processing your employment application,
we may conduct an investigation in which we will obtain or cause to be obtained a consumer
report from consumer reporting agencies. You are specifically notified that Founders Federal
Credit Union (FFCU) and its agents may obtain or cause to be obtained a credit report for
purposes of making employment decisions. You have a right under the Fair Credit Reporting
Act to know the information contained in your credit file at the consumer reporting agency.

RELEASE

I understand the above notification and agree to permit FFCU and its agents to conduct an
investigation as described above. By my signature below, I hereby authorize the release of
information from my records requested by FFCU, a prospective employer, and its agents. I hold
harmless any third party releasing information in reliance upon this release and FFCU and its
agents.

It is expressly understood and agreed that any information given may be used for the purpose of
determining my acceptability for employment. A photocopy of this authorization shall be
deemed as effective as the original.

______________________________ _____________________
Signature Date

______________________________ _____________________
Printed Name Social Security Number

______________________________
Address

______________________________ _____________________
City, State, Zip Witness

Completed form may be returned to Human Resources via:

Email: HR@FoundersFCU.com
US Mail: Founders FCU
Attn: Human Resources
737 Plantation Road
Lancaster, SC 29720
Fax: (803) 289-5087