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Employment Application

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Please fill out and submit. We also offer a printable version for your convenience. In order to be considered for employment, this application must be completed in full. Please indicate the specific job title for which you are interested in being considered.

Personal Data
Personal Data

* indicates a required field

General Information

If you are related to anyone in our company, please state their name and relationship to you.

Employment Desired *
Are you employed now *
If so, may we inquire of your present employer? *
How were you referred to us? *
If referred by employee:
Please explain:
Education
High School
Highest Earned
College
Degree Earned
Employment History
Employment History

List three most recent employers.

First employer
May we contact this employer?
Second employer
May we contact this employer?
Third employer
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References
Reference One
Reference Two
Reference Three
Blue Ridge Bank and Trust Co. is subject to certain nondiscrimination and affirmative action record-keeping and reporting requirements for the administration of civil rights laws and regulations under Executive Order 11246. In order to comply with the laws, we invite employees to self-identify their gender, ethnicity, and race. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and may only be used in accordance with provisions 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. For civil rights monitoring and enforcement purposes only, all race/ethnicity information will be collected and reported in the seven categories identified below. The definitions for each category have been established by the federal government. If you choose to voluntarily self-identify, you may mark only one of the boxes presented below. If you choose not to identify your race/ethnicity at this time, the federal government requires this employer to determine this information by visual survey and/or other available information. When reported, data will not identify any specific individual.
Voluntary Disclosure
Indicate Gender:
Indicate Ethnic Group:
Indicate your Race:
Revised EEO-1 Race and Ethnicity Categories Descriptions
Hispanic or Latino A person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White
 A person having origins in any of the original peoples of Europe, the Middle East, or North America.
Black or African-American
 A person having origins in any of the black racial groups of Africa.
Asian
 A person with 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.
Native Hawaiian or Other Pacific Islander
 A person having origins in any of the people of Hawaii, Guam, Samoa, or other Pacific Islands.
American Indian or Alaskan Native A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races
 All persons who identify with more than one of the above races or ethnicities.

 

Blue Ridge Bank and Trust Co. is an equal opportunity employer and does not discriminate on the basis of race, color, sex, national origin, religion, age, disability, veteran status pre- or post-hire. Individuals who may have inquiries regarding the corporation's policy and procedures should contact the Human Resource Dept. at 816-795-4041.

Definitions

As a federal government contractor, we are requesting information about veteran status in order to comply with government reporting requirements, and in order to ensure equal employment opportunity. We comply with all applicable laws including the Vietnam Era Veterans Readjustment Assistant Act of 1974, as amended by the Jobs for Veterans Act of 2002, 28 U.S.C. 4212 (VEVRAA), which requires government contractors to take affirmative action to employ and advance and employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; (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 veteran's 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 re-employed 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 Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

Reasonable Accommodation Notice

If you are a disabled veteran, it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability.

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 the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

Self-Identification

In an effort to comply with requirements regarding government record-keeping, reporting, and other legal obligations, which may apply, we invite you to complete this data survey. Submission of this information is voluntary and will be kept confidential. We are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified "protected veteran" category. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. If you are not a veteran, select box 1 OR select the box(es) that apply to your veteran status. Failure to provide information will not subject you to any adverse personnel decision or action.

Veteran
Veteran Status *
Protected Veteran Information

I belong to the following classifications of protected veterans (Choose all that apply):

Military Discharge Date:

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilitiesi. To help us measure how well we are doing, we are asking you to tell us if you have a disability, or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private, and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I 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 (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 (example: Crohn's disease or irritable bowel syndrome)
  • Intellectual disability
  • Missing limbs or partially missing limbs
  • Nervous system condition (example: migraine headaches, Parkinson’s disease, or multiple sclerosis)
  • Psychiatric condition (example: bipolar disorder, schizophrenia, PTSD, or major depression)
Disability
Please check one of the boxes below:

Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

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.

Equal Opportunity Employer

Blue Ridge Bank and Trust Co. is an equal opportunity employer and does not discriminate on the basis of race, color, sex, gender identity, national origin, age, disability, veteran status, marital status, sexual orientation, genetic information, or any other protected characteristic under applicable law pre- or post-hire. Questions should be directed to the Human Resource Department at 816-795-4041.

Equal Opportunity Employer
Please check one of the boxes below:

This Organization Participates in E-Verify

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment.

Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9.

E-Verify Works for Everyone

For more information on E-Verify, or if you believe that your employer has violated its E-Verify responsibilities, please contact DHS.


Esta Organización Participa en E-Verify

Este empleador participa en E-Verify y proporcionará al gobierno federal la información de su Formulario I-9 para confirmar que usted está autorizado para trabajar en los EE.UU.

Si E-Verify no puede confirmar que usted está autorizado para trabajar, este empleador está requerido a darle instrucciones por escrito y una oportunidad de contactar al Departamento de Seguridad Nacional (DHS) o a la Administración del Seguro Social (SSA) para que pueda empezar a resolver el problema antes de que el empleador pueda tomar cualquier acción en su contra, incluyendo la terminación de su empleo.

Los empleadores sólo pueden utilizar E-Verify una vez que usted haya aceptado una oferta de trabajo y completado el Formulario I-9.

E-Verify Funciona Para Todos

Para más información sobre E-Verify, o si usted cree que su empleador ha violado sus responsabilidades de E-Verify, por favor contacte a DHS.



888-897-7781

dhs.gov/e-verify

Insert e-verify badges here.

E-Verify
Please check one of the boxes below:
Resume/Cover Letter/Relevant Documents
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File Upload Two

Applicant's Statement: I hereby certify that I have read and fully understand the questions asked in this application and that the answers given on this application (and accompanying documents, if any) are true and complete to the best of my knowledge. I also understand and agree that any misstatement, falsified information, or omission of any fact from or on this application or during any interview may disqualify me from further consideration from employment and/or may be considered justification for dismissal if discovered after an offer of employment has been extended, or after I have been hired.

Further, I understand that Missouri is an employment-at-will state, as such my employment may be ended by either me or my employer, at any time, with or without cause. I hereby give consent to any and all prior employers of mine to provide information with regard to my employment with prior employers to the Bank.

I understand that nothing contained in this employment application or in the granting of an interview is intended to lead or create an offer, employment contract, or a guarantee of employment for a specific period of time between the Bank, any subsidiary or an affiliate, unless made in writing. I understand that any hiring decision is contingent upon my successful completion of all the Bank's lawful pre-employment checks, which may include a criminal background check, a credit check or a pre-employment test if appropriate. I agree to execute any consent forms necessary for the Bank to conduct its lawful pre-employment checks.

Employment will be contingent on providing proof of their identity and authorization for employment in the United States pursuant to the Immigration Reform and Control Act of 1986.

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