Routing Number: 271291460 (219) 874-6943 - Michigan City, IN (219) 762-6228 - Portage, IN Locations Contact
Name:
Job applying for:
Address:
Phone:
-
E-mail:
Desired salary:
Date available to begin work:
Please specify days and hours you are available.
Have you ever worked for this company?
If yes, when?

Citizenship

Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?

Education

High School attended:
High School address:
High School dates attended:
Did you graduate high school?
High School diploma:
College attended:
College address:
College attended dates:
Did you graduate college?
College degree:
Other education:
Other address:
Other dates attended:
Did you graduate other?
Other degree:

Military Service

Branch:
Service dates:
Rank at discharge:
Type of discharge:
If other than honorable, please explain:

Previous Employment


List employment history starting with most current employment.

Employer 1 name:
Employer 1 phone:
-
Employer 1 address:
Employer 1 supervisor:
Employer 1 job title:
Employer 1 salary:
Employer 1 responsibilities:
Employer 1 employment dates:
Reason for leaving employer 1:
May we contact employer 1 supervisor?
Employer 2 name:
Employer 2 phone:
-
Employer 2 address:
Employer 2 supervisor:
Employer 2 job title:
Employer 2 salary:
Employer 2 responsibilities:
Employer 2 employment dates:
Reason for leaving employer 2:
May we contact employer 2 supervisor?
Employer 3 name:
Employer 3 phone:
-
Employer 3 address:
Employer 3 supervisor:
Employer 3 job title:
Employer 3 salary:
Employer 3 responsbilities:
Reason for leaving employer 3:
May we contact employer 3 supervisor?

References

Reference 1 name:
Reference 1 relationship:
Reference 1 company:
Reference 1 phone:
-
Reference 1 address:
Reference 2 name:
Reference 2 relationship:
Reference 2 company:
Reference 2 phone:
-
Reference 2 address:
Reference 3 name:
Reference 3 relationship:
Reference 3 company:
Reference 3 phone:
-
Reference 3 address:

Authorization for permission to release confidential information:

I hereby authorize Trans Union. and its employees to verify, obtain copies of records and gather any information required to complete an Investigative Consumer Report pertaining to my submitting application for employment with MEMBERS ADVANTAGE CREDIT UNION.


Authorization

l understand and give my permission to release any and all information from your files as permitted by law pertaining to Driving Records, Law Enforcement and Public Court Records, Credit Records, Employment and Education Records.

Release of Liability

  • I hereby forever release and discharge Trans Union and its officers, directors, shareholders, agents and employees, as well as successors, assigns and all other persons acting on its behalf, from any claims, liability, action for damages compensation or otherwise, known or unknown, on account of or arising out of the investigation and disclosure of the requested information.
  • I further release and discharge all liability from all companies, agencies, officers, officials, employees, and persons providing good faith, pertinent information and/or records as requested to successfully complete an Investigative Consumer Report for my application of employment.