Employment Application
Submitter Information (Required)
First Name (required)
Last Name (required)
Resolve the errors marked in red before submitting again.

Privacy Policy:
Our privacy policy protects the privacy of your personally identifying information that you provide us online.

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1. Print this application and gather the information you'll need.
2. Complete the application online and click "Submit Application" or fax it to 570-253-0785.
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The Honesdale National Bank provides equal access to programs, services and employment opportunities without regard to sex (including pregnancy), race, color, religion, national origin, citizenship, age, disability, genetic information or any other bias protected by federal, state and/or local law.

In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations of the application and/or interview process should notify the Director of Human Resources. Examples of reasonable accommodations include making a change to the application process; providing written materials in an alternate format such as braille, large print or audio recordings; using a sign language interpreter; using specialized equipment; or modifying testing conditions.

Personal Information
Application Date
First NameMiddle InitialLast Name
(required) (required)
SS Number and Contact Information
Social Security No.Phone NumberEmail Address
(required) (required) (required)
Address Information (required)
Are you 18 years of age or older? (required)
If not, do you have a valid work permit?
Employment Desired
Position Information
Position Applied ForDate You Can StartWage/Salary Desired
Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation?
This question is not designed to elicit information about an applicants disability. Please do not provide information about the existence of a disability, particular accommodation or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
Are you currently employed? (required)
If yes, may we contact your present employer?
If no, please explain.
Have you ever applied with us before? (required)
If yes,
Were you offered a position? (required)
High School
(required) (required)
Years Completed (required)
Graduated (required)
Graduated (required)
Degree Obtained
Business, Trade, or Correspondence School
Years Completed
Graduated (required)
Subjects Studied
Other Study or Research
Job-related skills typing, etc.
List your last three employers starting with the most recent.
Employer 1
NameAddressStart DateEnd Date
Employer 1 continued
PositionEnding Salary/WageReason For Leaving
Employer 2
NameAddressState DateEnd Date
Employer 2 continued
PositionEnding Salary/WageReason For Leaving
Employer 3
NameAddressStart DateEnd Date
Employer 3 continued
PositionEnding Salary/WageReason For Leaving
Please list three references.
Reference 1
NamePhone NumberEmail Address
Reference 1 continued
# of Years KnownRelationship
Reference 2
NamePhone NumberEmail Address
Reference 2 continued
# of Years KnownRelationship
Reference 3
NamePhone NumberEmail Address
Reference 3 continued
# of Years KnownRelationship
Other Information
Do you have the legal right to work in the U.S.? (required)
If hired, it will be necessary for you to promptly submit documentation of your identity and right to work in the U.S.
List any days or hours when you are not available to work.
Have you ever been convicted of a crime? (required)
If yes, describe the facts and circumstances and give the dates and locations.
Have you ever been discharged or asked to resign from a position? (required)
Please provide a detailed explanation of all prior disciplinary problems and/or actions.

I certify that all information I have provided in order to apply for a secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persona, corporations or organizations for furnishing such information about me.

The Honesdale National Bank is an Equal Opportunity Employer

I understand that this application remains current for one year. At the conclusion of that time, If I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer.

This company does not tolerate unlawful discrimination in its employment practices. No question on this application is uses for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex (including pregnancy), race, color, religion, national origin, citizenship, age, disability, genetic information or any other protected status under applicable federal, state, or local law.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to 1) eliminate me from further consideration for employment; 2) may result in my immediate discharge from the employer's service, whenever it is discovered.

By selecting "Submit Form," I certify that I have read and fully understand and accept all terms of the foregoing Applicant Statement



The Honesdale National Bank is an Equal Opportunity Employer