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Personal Information:

*Today's Date:
*Street Address:
*City, State Zip: ,
*Cell Phone Number: ( ) -
Home Phone Number: ( ) -
*Email Address:
Referred by:

Employment Desired:

*Status Desired: Full Time   Part Time   Seasonal
Desired Salary Range:
*Hours/Days Available:
*Date you can start:
*Have you ever applied
to Franklin before?
Yes No
**If so,when:


High School:
*Name and Location:
Areas of Study:
*Did You Graduate? Yes No
College/Vocational/Business School:
Name and Location:
Areas of Study:
Degree Received: Yes No
Name and Location:
Areas of Study:
Degree Received: Yes No
Other Areas of Study:

Employment Experience (Begin with most recent employer.):

City, State Zip: ,
Dates Employed: From To
Reason for Leaving:
City, State Zip: ,
Dates Employed: From To
Reason for Leaving:
City, State Zip: ,
Dates Employed: From To
Reason for Leaving:
Other related skills i.e. Sales, Customer Service, Computer Applications, Cash Handling, Military Service etc.


Please do not include any relatives

City, State Zip: ,
How Acquainted:
Years Acquainted:
City, State Zip: ,
How Acquainted:
Years Acquainted:
City, State Zip: ,
How Acquainted:
Years Acquainted:

Please read the following disclosure and answer the applicable questions.

Franklin Bank is an equal opportunity employer. We are dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability, or national origin. Consistent with the Americans Disabilities Act, applicants may request accommodations needed to participate in the application process.

If Franklin Bank hires you, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. Franklin Bank also conducts a background check. You cannot be hired if you cannot comply with these requirements.

*Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment
Yes No

Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020

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 disabilities. 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:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)

*Please check one of the boxes below:

  YES, I HAVE A DISABILITY (or previously had a disability)

*Your Name

Today's Date

Reasonable 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.

Invitation to Self-Identify

This company is subject to Executive Order 11246, as amended, which requires Federal contractors to ensure that applicants are employed and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. We are therefore requesting information about race and gender in order to comply with government reporting requirements and in order to ensure equal employment opportunity.

Submission of this information is voluntary and will be kept confidential. 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 Federal affirmative action regulations.

*Name :
Date :
Position :

*Gender :


*Race/Ethnicity :

  WHITE (not Hispanic or Latino)
  BLACK or AFRICAN AMERICAN (not Hispanic or Latino)
  ASIAN (not Hispanic or Latino)
  AMERICAN INDIAN/ALASKA NATIVE (not Hispanic or Latino)
  NATIVE HAWAIIAN or PACIFIC ISLANDER (not Hispanic or Latino)
  TWO or MORE RACES (not Hispanic or Latino)

This company is also subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment veterans in the following classifications:

  • 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.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

*Veteran's section :


AUTHORIZATION; Please read and then scroll down to submit application.

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by Franklin Bank.

I authorize Franklin Bank to thoroughly investigate all statements contained in my application or resume. Furthermore, I authorize my former employers and references to disclose information regarding my former employment, character, and general reputation to Franklin Bank, without giving me prior notice of such disclosure. In addition, I release Franklin Bank, any former employers, and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during my interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or Franklin Bank. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Franklin Bank.

I understand that my employment or continued employment, to the extent permitted by law, may be contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by Franklin Bank's Drug and Alcohol Policy.

I understand that filling out this form does not indicate there is a position open and does not obligate Franklin Bank to hire. If hired, I agree to abide by all company work rules, policies and procedures. Franklin Bank retains the right to revise its policies or procedures, in whole or in part, at any time.

Applications shall be considered active for 90 days.

Please forward a copy of your resume to rzane@franklinbnk.com

* indicates a required field      ** indicates a required field based upon a previous selection