Employment Application



  • Belmont Savings Bank (includes all branches and all affiliated companies) does not discriminate on the basis of race, color, religion, national origin, sex, age, disability, ancestry or any other category protected by local, state or federal law. It is our intention that all qualified applicants are given equal opportunity. Applications may not be retained for longer than 12 months.

  • Desired Position: *

  • Office Location: *

  • Date of Availability: *

  • Work Status Desired (Select All That Apply): *






  • How Did You Find out About This Position?:

  • Desired Wage: *

  • Personal Information:





  • Are there any times of the day you cannot work?: *



  • If Yes, Please List Days You are Unavailable:

  • Are you legally allowed to work in the United States?: *



  • Do you have any relatives employed by Belmont Savings Bank?: *



  • Do you have proof that you are of legal age to perform the job for which you are applying?: *



  • Have you ever been convicted of a crime in the last seven (7) years? : *



  • If Yes, Please Explain:

  • * A "yes" answer or conviction does not automatically disqualify you from employment. Factors such as the date of the offense, seriousness and nature of the offense, rehabilitation and relationship of the offense to the position for which you are applying will be considered.

  • Are you now (or expect to be) employed by another business?: *



  • If Yes, Please Explain:

  • Have you ever had a professional license/credential revoked, suspended, (etc.) within an industry related to banking or finance?: *



  • If Yes, Explain:

  • Education:


  • List most recently attended institution first.

    Complete this section even if information is submitted on a resume.

  • School Name: *


  • Major/Field of Study: *

  • Degree Attained: *

  • _______________________________________

  • School Name:


  • Major/Field of Study:

  • Degree Attained:

  • _______________________________________

  • School Name:


  • Major/Field of Study:

  • Degree Attained:

  • List Any Scholastic/Professional Awards Earned:

  • Employment History:


  • Employer Name: *

  • Name of Supervisor: *


  • Phone: *

  • Current/Ending Salary: *


  • Title/Duties: *

  • Reason for Leaving: *

  • _______________________________________

  • Employer Name:

  • Name of Supervisor :


  • Phone:

  • Current/Ending Salary:


  • Title/Duties:

  • Reason for Leaving:

  • _______________________________________

  • Employer Name:

  • Name of Supervisor:


  • Phone:

  • Current/Ending Salary:


  • Title/Duties:

  • Reason for Leaving:

  • May we contact your current/former employer?: *



  • References:




  • Relationship:

  • _______________________________________



  • Relationship:

  • _______________________________________



  • Relationship:

  • Specialized Skills:


  • Please list all software applications (ex: Microsoft Word) and operating systems, which you are proficient in: *

  • Please list any professional/trade/business credentials you have:

  • Application of Employment Affidavit:


  • PLEASE READ EACH STATEMENT CAREFULLY BEFORE DIGITALLY SIGNING.

    I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND AND ACKNOWLEDGE THAT I HAVE BEEN HIRED AT THE WILL OF BELMONT SAVINGS BANK AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE AND THAT I MAY LIKEWISE RESIGN AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.

    I authorize the employers, organizations, and persons stated on this application to give Belmont Savings Bank (including all branches and affiliated entities) any and all information (except information which cannot be obtained as a matter of law) and records concerning my previous employment and education and I release and hold harmless of said employers, organizations or persons from all claims and damages arising out of the provision of this information and/or records to Belmont Savings Bank.

    I also understand that all employment is contingent upon my passing a pre-employment drug test, criminal background screen, and possibly a medical examination (as appropriate) after a conditional offer of employment has been made. I further understand that my employment is contingent upon my consent to the attainment and release of consumer or investigative report(s) regarding me, and that my employment is contingent upon Belmont Savings Bank s review of the information contained in any such consumer or investigative consumer reports(s). These reports may be obtained at any time after receipt of this authorization and throughout my employment, as provided by law. I have read the notice separately and provided to me regarding the attainment of such reports and my consent is given by signature below.

    I also understand that Belmont Savings Bank at its sole discretion, may alter, amend, or eliminate its existing employment policies, procedures, practices, compensation systems and other privileges and benefits at any time, with or without cause and/or notice (except where notice is required by law).

    I CERTIFY that all information provided in this application for employment is true and complete. I understand that any false information or omission of information may disqualify me from further consideration for employment and can result in termination of my employment if discovered at a later date while employed.

  • Signature: *

  • Date: *


* = Required