2027 E.

Monument Street
Baltimore, Maryland 21287
(410) 534-4500 fax: (410) 327-2167

Johns Hopkins Federal Credit Union is an equal opportunity employer and affords equal opportunity to all
applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran
status or any other status protected under local, state or federal laws.

Position(s) Applied For Date of Application (mm/dd/yyyy)

Last Name First Name Middle Name

Address City State Zip Code

Telephone Number Alternate Number

How Did You Hear About Us? [ ] Newspaper Ad ] Employment Agency [ Internet

Current Employee _____________________ Other _____________________

Are you legally eligible to work in the United States? YES NO

(Proof of eligibility will be required upon offer of employment)
Are you 18 years of age or older? YES NO
(If no, you may be required to provide authorization)
Can you with or without reasonable accommodation perform the essential functions of this
job? (If you have any questions about the functions of the job, please ask the interviewer YES NO
before answering this question.)
Have you ever applied to JHFCU before? (If yes, please give date.) __________ YES NO
Have you ever been employed with JHFCU before? (If yes, please give date.) ___________ YES NO

Have you ever been convicted of a felony/misdemeanor? (A conviction will not necessarily disqualify you.) YES NO

If yes, please explain: ________________________________________________________________

___________________________________________________________________________________
Can you travel if the job requires it? YES NO

Have you ever been refused a surety bond? YES NO

When would you be available to start this position? DATE ________

Is anyone related to you employed by Johns Hopkins Federal Credit Union? YES NO
If yes, please give their name and relationship to you. _______________________________
 EDUCATION
Name and Location Course of Study # of Years Diploma/
of School or Major Completed Degree

High School

College

Graduate

Vocational

Please list any academic honors, scholarships, offices held, etc.(Do not list any which reflect your race, color,
religion, gender, national origin, age, disabilities or veteran status.)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
________________________________________________________________________

Describe any specialized training, apprenticeships, licenses or skills.

_____________________________________________________________________________________________
_____________________________________________________________________________________________
________________________________________________________________________

Computer Proficiency: Check which best describes your current level of aptitude in the following areas:
None Basic Advanced Expert

Personal Computer    

Microsoft Word    

Microsoft Excel    

Adding Machine    

Other (Specify) __________________________

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EMPLOYMENT HISTORY (Begin with current or most recent employer. Do not exclude any employment.
Include any applicable temporary employment attach another sheet if necessary. Previous salaries or wages will
not be used to determine compensation at Johns Hopkins Federal Credit Union.)
Company Name Employment Dates Salary Name and Title of Supervisor
From To Start End
(mm/yy) (mm/yy)
Address
$ $

Phone Job title and description of duties:

May we contact this employer?

Yes No
Reason for leaving and explanation

Company Name Employment Dates Salary Name and Title of Supervisor

From To Start End
(mm/yy) (mm/yy)
Address
$ $

Phone Job title and description of duties:

May we contact this employer?

Yes No
Reason for leaving and explanation

Company Name Employment Dates Salary Name and Title of Supervisor

From To Start End
(mm/yy) (mm/yy)
Address
$ $

Phone Job title and description of duties:

May we contact this employer?

Yes No
Reason for leaving and explanation

Company Name Employment Dates Salary Name and Title of Supervisor

From To Start End
(mm/yy) (mm/yy)
Address $ $

Phone Job title and description of duties:

May we contact this employer?

Yes No
Reason for leaving and explanation
REFERENCES (Please list three persons, who are not related to you or previous supervisors, who can provide
professional references.)

Phone Years
Name Address Relationship/Occupation
Number Known

For Use By Human Resources Only

Arrange Interview  Yes  No

Remarks__________________________________________________________________________
_________________________________________________________________________________
________________________________________________________________________

Was the candidate hired?  Yes  No

If yes, what is the hire date? _____________________

Job Title __________________ Hourly Rate/Salary_______________ Department _________

_________________________________ _________________________
Interviewer Date
 APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION

*PLEASE READ CAREFULLY BEFORE SIGNING*

I hereby certify that all of the information provided by me in this application (or any other accompanying or required
documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification,
misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate
termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of
employment be extended by Johns Hopkins Federal Credit Union Corporation (hereinafter referred to as "JHFCU") that
such employment with JHFCU is at will, for no specified duration and may be terminated by either JHFCU or myself at any
time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of
JHFCU or its representatives used during the employment process is deemed a contract of employment real or implied. I
understand that no representative of JHFCU except the CEO has the authority to enter into any agreement guaranteeing any
conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be
made in writing and signed by the CEO of JHFCU.

I understand that if offered a position with JHFCU, I may be required to submit to a pre-employment criminal background,
reference, and credit checks as conditions of employment. I understand that unsatisfactory results from, refusal to cooperate
with, or any attempt to affect the results of these pre-employments checks will result in withdrawal of any employment offer
or termination of employment if already employed.

I herby authorize any and all schools, former employers, references, courts and any others who have information about me
to provide such information to Johns Hopkins Federal Credit Union and/or any of its representatives, agents or vendors and
I release all parties involved from any and all liability for any and all damage that may result from providing such
information.

I understand that this application is considered current for three months. If I wish to be considered for employment after
this period I must fill out and submit a new application.

UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICATION FOR
EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A
POYGRAPH, LIE DETECTOR TEST, OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR
CONTINUEDEMPLOYMENT. ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A
MISDEMEANOR AND SUBJECT TO A FINE NOW TO EXCEED $100.00

BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE
STATEMENTS.

_____________________________________________________________________________________
Signature Date (dd/mm/yyyy)

Name and number of person completing this form if other than applicant: _____________________________________

JOHNS HOPKINS FEDERAL CREDIT UNION IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL
QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR,
RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS
PROTECTED BY LAW.
 Johns Hopkins Federal Credit Union
20207 E. Monument Street
Baltimore, Maryland 21287
Telephone: 410-534-4500
Fax: 410-327-2167
Website: www.jhfcu.org
E-mail: [email protected]

Credit Check Authorization

Permission to Request Credit Report from Consumer Reporting Agency for Employment Purposes as
Defined by the Fair Credit Reporting Act.

As a condition of potential employment with Johns Hopkins Federal Credit Union, I understand that a
report on my credit history may be ordered through a Consumer Reporting Agency. With that in mind, I
hereby authorize the Credit Union to request a consumer credit report on my credit history through a
Consumer Reporting Agency. I understand that the information being obtained with not be used in
violation of any federal, state or local equal employment law or regulation, and that, if adverse action is
taken based on the consumer report, a copy of the report and a summary of rights will be provided to me.

_____
Print Name Date (mm/dd/yyyy)

______
Applicant’s Signature Social Security Number

_____________________ ______
Current Address