EmailMe Form - Employment Application

Position *

When can you start? *

MM / DD / YYYY

Are you willing to relocate? *

Yes

No

Referred by:

Upload Your Resume

Word or PDF Documents Only

Instructions

Please read carefully. Every item on this form must be answered to the best of your ability. Your qualifications will be carefully reviewed and you will be given thorough consideration for the position(s) for which you have applied. Upon employment, this application will become part of your permanent record at Town & Country Bank and Trust Co. Keep this in mind as you complete it. Special Note: You are not required to supply any information that is prohibited by Federal, State, or Local law. We are an Equal Opportunity Employer. Town & Country Bank and Trust Co. does not discriminate on the basis of race, color, religion, gender, national origin, pregnancy, marital status, citizenship, age, disability, veteran status, or any other legally protected class. You may request assistance in completing this application.

Contact Information

First Name *

Last Name *

Full Name *

Email *

Mobile Phone *

### - ### - ####

Home Phone *

### - ### - ####

Fax Number

### - ### - ####

Address *

City *

State *

Zip/Postal Code *

Country/Region *

Personal Information

If younger than 21, state your age here

Are you legally entitled to work in the United States?** *

Yes

No

**Compliance with I-9 requirements is mandatory, upon employment

Have you been convicted of a crime? *

Yes

No

If convicted of a crime(s), explain here:

A criminal conviction may or may not prohibit you from employment here

Have you ever been convicted of a moving traffic violation? *

Yes

No

If yes, list all here:

Have your driving privileges ever been revoked or suspended? *

Yes

No

If yes, list here when and why:

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