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Employment Application
1177 Avenue of the Americas, New York, NY 10036
Equal Opportunity Employer
Bank Hapoalim B.M. provides equal employment and individual opportunity to all job applicants
and employees without regard to race, color, religion, sex, sexual orientation, veteran status,
marital status, age, national origin, veteran or disability and any other status protected by law.
Personal Information
Position Desired
Date: _________________
Date Available
Salary Desired
Home Phone
(
Print Name (Last, First, Middle)
)
Business Phone
(
)
Street Address (No., Street, Apt., No.)
City, State, Zip Code
Social Security No.
List a cell phone number and email address where you can be reached
How were you referred to Bank Hapoalim B.M.?
BH Employee
Employment Agency
Internet
Newspaper Ad
Other Referral
(Name)
(Name of Firm)
(Source)
(Which paper)
(Please explain)
Rev. 7/07
Page 2
Are you legally authorized to work in the United States?
Yes
No
Will you now or in the future require sponsorship for employment visa status (e.g. H-1B visa?)
Yes
No
Are you at least 18 years of age and, if not, do you have valid working papers?
Are you able to perform the functions of the job with or without reasonable accommodations?
Yes
No
Yes
No
Are you available to work overtime if requested?
Yes
No
Have you been employed by or previously applied to Bank Hapoalim B.M. or any of its subsidiaries?
Yes
No
Yes
No
Yes
No
Yes
No
If No, please describe any accommodation required:
If Yes, specify dates: Employed from
to
Applied on
Does Bank Hapoalim B.M. now employ any of your relatives?
If Yes, state name and relationship:
Is additional information relative to a change of name, use of an assumed name or nickname
necessary to enable a check on your work record?
If Yes, what name?
Have you ever been convicted of an offense other than a minor traffic violation?
If Yes, please note that a conviction or a pending criminal case will not result in an automatic disqualification from
employment. The date(s), nature, seriousness of the offense, and rehabilitation will be considered. However, please be
advised that Section 19 of the Federal Deposit Insurance Act states that without the written permission of the FDIC, no
person who has been convicted of any criminal offense involving dishonesty or a breach of trust or money laundering
may participate, directly or indirectly, in the conduct of the affairs of an insured bank.
If Yes, state date, place, and nature of each conviction.
Bank Hapoalim B.M. verifies the information provided by you in your application for employment, including
educational and employment references. As part of the verification process, you may be asked to provide copies
of degrees/diplomas. Bank Hapoalim B.M. may terminate your employment upon discovery of any discrepancy.
Please ensure that all of the information you provided is correct and that the dates, degrees received and
educational information is accurate.
Education
Number of
years completed
Name and Address of School
Did you
graduate?
High School
College
Graduate
School
Supplemental
Education
Are you currently attending school?
Yes
No
If Yes, name of school, days and times attending:
If No, do you plan to return?
Yes
(
F/T
P/T )
No
Degree Rec’d
Courses/Major
Credits
completed
Page 3
Employment
Include U.S. Military service only if relevant. Do not show type of discharge.
May we contact your present employer?
Yes, you may contact anytime
Yes, contact upon acceptance of employment
List your current or most recent employer first and indicate a continuous record of employment for the last ten years or
from the time you left school.
From Mo/Yr to Mo/Yr
Name and Address of most recent employer
Job Title
Duties and Responsibilities
Reason for Leaving
Supervisor’s Name and Phone No.
From Mo/Yr to Mo/Yr
Name and Address of most recent employer
Job Title
Duties and Responsibilities
Reason for Leaving
Supervisor’s Name and Phone No.
From Mo/Yr to Mo/Yr
Name and Address of most recent employer
Job Title
Duties and Responsibilities
Reason for Leaving
Supervisor’s Name and Phone No.
From Mo/Yr to Mo/Yr
Name and Address of most recent employer
Job Title
Duties and Responsibilities
Reason for Leaving
Supervisor’s Name and Phone No.
Starting Salary
Starting Salary
Starting Salary
Starting Salary
Final Salary
Other Comp.
Final Salary
Other Comp.
Final Salary
Other Comp.
Final Salary
Other Comp.
EXPLAIN ANY GAPS IN EMPLOYMENT:
Skills
PC Software
Do Not Complete Unless Boxes Below Identify Specific Languages
Proficiency
Basic
Basic
Basic
Basic
Basic
Professional Licenses
Inter.
Inter.
Inter.
Inter.
Inter.
Languages other than English (complete only if required for position)
Adv.
Adv.
Adv.
Adv.
Adv.
Fluency
(circle one)
Speak
Read
Write
Basic Inter. Adv.
Basic Inter. Adv.
Basic Inter. Adv.
Fluency
(circle one)
Speak
Read
Write
Basic Inter. Adv.
Basic Inter. Adv.
Basic Inter. Adv.
Fluency
(circle one)
Speak
Read
Write
Basic Inter. Adv.
Basic Inter. Adv.
Basic Inter. Adv.
License Expiration Date:
Please read the following statements carefully as they represent matters of importance to both you and Bank Hapoalim B.M.
regarding this employment application:
INVITATION TO APPLICANTS FOR EMPLOYMENT TO IDENTIFY THEMSELVES AS DISABLED
THIS SECTION PERTAINS ONLY TO DISABLED PERSONS. A “Disabled Person” refers to any person who has a physical or
mental impairment that substantially limits one or more major life activities (performing manual tasks, learning, walking, seeing, hearing,
speaking, etc.), has a record of such an impairment or is regarded as having such an impairment. Bank Hapoalim B.M. is a Government
Contractor subject to Section 503 of the Rehabilitation Act of 1973 which requires employers to take affirmative action to employ and
advance in employment qualified disabled individuals. If you feel you meet the above definition of “Disabled,” Bank Hapoalim B.M.
invites you to inform us so that you may be given consideration under our Affirmative Action Program.
Provision of this information is entirely voluntary, and choosing not to provide it will not result in any adverse treatment. The information will
be used only according to the regulation of the Act and will be kept in the individual’s personnel file. The information is considered
confidential, except that, (1) Supervisors may be informed regarding restrictions on the work or duties of handicapped persons and any
necessary accommodations; (2) First Aid personnel may be informed, where appropriate, if the condition might require emergency treatment; and (3) Government officials investigating compliance with the Act shall be informed.
PLEASE DESCRIBE DISABILITY:
If you have a disability which might affect your performance or create a hazard to yourself or others in connection with the job for which
you are applying, please indicate below (1) the skills, procedures and aids you use or intend to use to perform the job and (2) the accommodations Bank Hapoalim B.M. could make which would enable you to perform the job properly and safely, such as special equipment,
changes in the physical layout of the job, and/or changes in certain duties of the job.
CONFLICT OF INTEREST
Are you presently a director, employee or officer of a bank located in the United States that is unaffiliated
with Bank Hapoalim B.M.?
Yes
No
Do you intend to continue in that capacity if hired by Bank Hapoalim B.M.?
Yes
No
Yes
No
If Yes, please give the name of the Bank:
Do you currently hold a position of employment for pay in any organization outside of Bank Hapoalim B.M.
not mentioned above in which you plan to continue working if employed by Bank Hapoalim B.M.?
If Yes, please provide the following information:
Name of Organization:
Position and Title Held:
Signature of Applicant
Date
DECLARATION OF APPLICANT (PLEASE READ BEFORE SIGNING)
I certify that the information given by me in this application is true and complete. I understand and agree that any false information, misrepresentation, or concealment of fact will result in my immediate discharge without recourse or in refusal of employment by Bank Hapoalim B.M.
I understand and agree that all information furnished in this application may be verified by Bank Hapoalim B.M. I also understand that my
employment is subject to a satisfactory check of references and satisfactory results of any medical examination that the Bank may require.
I hereby authorize all individuals and organizations named or referred to in this application and any law enforcement organization to give
Bank Hapoalim B.M. all information relative to my employment, work habits, and character and hereby release such individuals, organizations, and Bank Hapoalim B.M. from any liability for any claim or damage which may result.
In connection with this application, or during the course of my employment, I understand that Bank Hapoalim B.M. may request that a
Consumer Reporting Agency prepare a report regarding my credit worthiness, credit standing and credit capacity, character, general reputation, personal characteristics and mode of living. I further understand that upon my request, Bank Hapoalim B.M. will inform me whether
or not a consumer report was requested and, if a report was requested, will inform me of the name and address of the agency furnishing
the report. I further understand that upon my written request made within a reasonable period of time, I have the right to inspect and receive
a copy of such report by contacting the agency.
In the event I am hired, I agree to comply with Bank Hapoalim B.M.’s policies and procedures. Further, I understand and agree that my
employment is “at will,” shall be for no definite period and, regardless of the date of payment of my salary, shall be terminable at any time
by me or the Bank, for any reason and without any previous notice.
Signature of Applicant
Date
FOR HUMAN RESOURCES DEPARTMENT USE ONLY
Human Resources Department Interview
Interviewed by
Date
Comments:
Disposition:
Thank you for considering
as your prospective employer.