Online Job Application

Because we do business with the US Government, we must reach out to, hire and provide equal opportunity to qualified individuals.

To help us measure how we are doing, in the following screens we are going to ask you to provide us with information about your race, gender, veteran status and if you have, or have had, a disability.

As part of this procedure we are going to invite you to complete the following:

Voluntary Self Identification of Gender, Ethnicity/Race
Voluntary Self Identification of Veteran Status
Voluntary Self Identification of Disability

Any answers you give will be kept private and will not be used against you in any way. You are not required to disclose any of this information and completion of the questionnaires is entirely voluntary.

Once you have completed this process, you will be directed to our application.

* indicates required field

Invitation to Self-Identify Gender, Ethnicity/Race

AmeriState Bank 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 and employees to voluntarily self-identify their gender, race and ethnicity.

Submission of this information is strictly voluntary and refusal to provide it will not subject you to any adverse treatment.

The information obtained will be kept confidential and may only be used in accordance with the provision 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. This information will be maintained separately from your application for employment. If you do not wish to self-identify at this time, you may do so in the future by submitting this form. Failure to provide the following information will not subject you to any adverse action or treatment.

AmeriState Bank is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.

Gender Male Female Decline to Identify

Ethnicity/Race

Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race having origins.

White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above five races.

Decline to Identify

Invitation to Self-Identify Protected Veteran Status

AmeriState Bank 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 veterans 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 Labors 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 OFCCP, or enforcing the Americans with Disabilities Act, may be informed.

Please select one of the choices below

I identify as one or more of the classifications of protected veteran listed above

I am not a protected veteran

I do not wish to identify at this time

Voluntary Self-Identification of Disability

Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 05/31/2023

Why are you being asked to complete this form?
We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:

Autism
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
Blind or low vision
Cancer
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or hard of hearing
Depression or anxiety
Diabetes
Epilepsy
Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
Intellectual disability
Missing limbs or partially missing limbs
Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)
Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression

Please select one of the choices below

Yes, I Have a Disability, or Have a History/Record of Having a Disability

No, I Don't Have a Disability, or a History/Record of Having a Disability

I Don't Wish to Answer

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.

Personal Information

First Name* First Name is required

Preferred Name

Last Name* Last Name is required

Email* A valid Email address is required

Current Address

Address Line 1* Address line 1 is required

Address Line 2

City* City is required

State* State is required

Zip Code* Zip Code is required

Phone Numbers

Cell Phone* A valid phone number is required

Home Phone

Future Employment Information

Are you legally authorized to work in the United States? Yes No

If yes, select a length of time available for you to work.

Desired Compensation* Desired Compensation is required.

Available Start Date* Available Start Date is required.

How did you hear about this opportunity?* Please tell us how you heard about this opportunity

Are you related to anyone currently employed at AmeriState Bank? Yes No

If you are related to a current AmeriState Bank employee, please provide the employee's name.

If you were referred by a current AmeriState Bank employee, please provide the employee's name.

Desired Location

Position Applying for

Employment History

Please provide the following requested information regarding your employment history: Include military service assignments and volunteer activities. You may exclude organization names that include race, color, religion, gender, national origin, ancestry, age, disability or other protected status.

Are you currently employed?* Please select your current employment status Yes No

Current or Most Recent Employer

Employer Name* Employer Name is required.

City and State* Employer City and State are required.

Company Phone* Company Phone is required.

Title* Employer Title is required.

Pay Rate* Pay Rate is required.

Direct Supervisor* Direct Supervisor is required.

Responsibilities and Duties

Start Date* Start Date is required.

End Date

Reason for Leaving (if no longer employed)

OK to contact?

Yes

Second Previous Employer

Employer Name

City and State

Company Phone

Title

Pay Rate

Direct Supervisor

Responsibilities and Duties

Start Date End Date

Reason for Leaving

OK to contact?

Yes

Third Previous Employer

Employer Name

City and State

Company Phone

Title

Pay Rate

Direct Supervisor

Responsibilities and Duties

Start Date End Date

Reason for Leaving

OK to contact?

Yes

Education/Training

What is your highest level of education completed?* Select an option for highest level of education completed

Name(s) of Institution(s)

Did you graduate? Yes No

If yes, what year did you graduate? Name(s) of Major(s) Name(s) of Degree(s) or Certification(s) List any Professional Licenses

References

Please list three professional references

1st Reference

Name* Reference #1 Name is required.

Phone* Reference #1 Phone is required.

2nd Reference

Name* Reference #2 Name is required.

Phone* Reference #2 Phone is required.

3rd Reference

Name* Reference #3 Name is required.

Phone* Reference #3 Phone is required.

Applicant's Statement

I certify that my answers to all 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 or during the pre-employment process may be grounds for my immediate termination.

I have read and agree to this disclaimer You must agree to the above disclaimer

Applicant Signature* Applicant Signature is required.

Date* Application date is required.

Comments

By checking the box below, you acknowledge and consent to terms of the privacy policy which applies to the applicant tracking service being offered by Paycom on behalf of AmeriState Bank. The privacy policy offers an explanation of how and why your data will be collected, how it will be used and disclosed, how it will be retained and secured, and what legal rights are associated with that data (including the rights of access, correction, and deletion). The policy also describes legal and contractual limitations on these rights. The specific rights and obligations of individuals living and working in different areas may vary by jurisdiction.

I have read and agree to this statement You must agree to proceed

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