Application for Employment

Applicant Information

First Liberty Bank does not discriminate on any employment practice on the basis of race, religion, color, sex, age, national origin, marital status, veteran’s status, the presence of a non-job-related medical condition, or disability. No question on this application is intended to secure information which could be of a discriminatory nature.

Employment History


Personal References

Please list three references not related to you and who are not previous employers

Professional References

Please list three professional references.

Employment Data Record

First Liberty Bank is an affirmative action employer, and does not discriminate, and is subject to Federal regulations requiring reporting of certain information on applicants for employment. To assist in this effort, all applicants are requested to complete this form. Your cooperation is strictly voluntary. This form will be kept separate from your employment application and the information contained will be kept confidential. It will not be available to personnel involved in the hiring process. The information given will be used only for reporting purposes in accordance with Federal laws and regulations.

If you do not wish to provide this information, please print your name, the date and please indicate such fact in the appropriate space below. Your decision in this regard will not affect your application.

Applicant's Statement