international bancshares corporation is an ... - ibc … 03/2015 international bancshares...

INTERNATIONALBANCSHARES CORPORATION

International Bancshares Corporation is an Equal OpportunityAffirmative Action Employer.

REVISED 03/2015

INTERNATIONAL BANCSHARES CORPORATION

APPLICATION FOR EMPLOYMENT PLEASE PRINT OR TYPE

THE INFORMATION GIVEN ON THIS FORM IS FOR USE BY THE INTERNATIONAL BANCSHARES CORP. ANSWER EACH QUESTION FULLY AND ACCURATELY. THE USE OF THIS FORM DOES NOT INDICATE THAT THERE ARE ANY POSITIONS OPEN AND DOES NOT IN ANY WAY OBLIGATE IBC. THIS APPLICATION WILL BE KEPT ACTIVE FOR 60 DAYS. INTERNATIONAL BANCSHARES CORPORATION IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER.

IDEN

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CA

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N NAME (LAST, FIRST, MIDDLE) APPLICATION DATE

ADDRESS (INCLUDE ZIP) CITY STATE ZIP PHONE NUMBER (INCLUDE AREA CODE)

HOMEWORK OR

ARE YOU AUTHORIZED TO WORK IN THE U.S.?

❑ Yes ❑ No

EVER APPLIED OR BEEN EMPLOYED BY A IBC BANCORPORATION MEMBER? ❑ Yes ❑ No IF YES, WHERE WHEN

PER

SON

AL

POSITION DESIRED EMPLOYMENT DESIRED ❑ Full Time ❑ Regular ❑ Part Time ❑ Temporary

SALARY DESIRED DATE AVAILABLE WILL YOU PERFORM SHIFT WORK? ❑ Yes ❑ No

LIST OFFICE AND COMPUTER PROGRAM SKILLS WHO REFERRED YOU TO IBC?

❑ FRIEND WHO WORKS AT IBC?

NAME

❑ RELATIVE WHO WORKS AT IBC?

NAME

❑ NEWSPAPER

NAME OF NEWSPAPER

❑ AGENCY - NAME

❑ OTHER - EXPLAIN

EMAIL ADDRESS

FOREIGN LANGUAGE SKILLS

SPEAK READ WRITEHAVE YOU EVER BEEN BONDED?

❑ Yes ❑ No

HAVE YOU EVER BEEN REFUSED A BOND?

❑ Yes ❑ No

EDU

CA

TIO

N

SCHOOL NAME & LOCATION MAJOR / MINOR DEGREEGRADE AVERAGE

OVERALL MAJOR HIGH SCHOOL * DIPLOMA?

❑Yes ❑ NoCOLLEGE **

❑Yes ❑ NoGRADUATE OTHER (INCLUDE SPECIAL TRAINING, COURSES & APPRENTICESHIPS COMPLETED)

EXPLAIN ANY PLANS YOU HAVE FOR FURTHER STUDY * IF NOT A HIGH SCHOOL GRADUATE, INSERT NUMBER OF SCHOOL YEARS COMPLETED* * IF NO DEGREE HAS BEEN OBTAINED, INSERT NUMBER OF COLLEGE CREDIT HOURS COMPLETED

REF

EREN

CES

PERSONS FAMILIAR WITH YOUR WORK OR ACADEMIC BACKGROUND NAME POSITION & COMPANY LOCATION PHONE

FRIENDS OR RELATIVES WHO ARE EMPLOYEES OF THIS ORGANIZATION OR ANY BANK NAME RELATIONSHIP POSITION & COMPANY LOCATION

IBC-0280-01 REVISED 03/2015

EMPL

OYM

ENT

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LIST OF EMPLOYERS BEGINNING WITH PRESENT OR MOST RECENT NAME OF EMPLOYER LOCATION EMPLOYED PHONE FROM-MO/YR TO-MO/YR YOUR TITLE SUPERVISOR AND TITLE STARTING SALARY FINAL SALARY MAY WE CONTACT

THIS EMPLOYER? Yes NoREASON(S) FOR LEAVING DESCRIBE YOUR PRINCIPAL RESPONSIBILITIES

NAME OF EMPLOYER LOCATION EMPLOYED PHONE FROM-MO/YR TO-MO/YR YOUR TITLE SUPERVISOR AND TITLE STARTING SALARY FINAL SALARY MAY WE CONTACT






OTHER EMPLOYERS WITHIN THE PAST 10 YEARS, IF APPLICABLE

NAME OF EMPLOYERDATES

POSITIONFROM TO

I certify that the foregoing statements are true, complete and correct. I understand that the falsification or material omission of any of the information requested on this form or during my pre-employment interview will result in rejection of this application or, if discovered during my employment, may result in my dismissal. I authorize each person and entity identified above to disclose to the bank any and all information they may have concerning me, including my past performance, employment record and character. I expressly release these persons from any and all liability for furnishing responses to these inquiries. I authorize the bank to investigate my credit, my employment and personal background. If I am denied employment as a result of a credit report, the bank will inform me of this reason and the name and address of the reporting agency that supplied the report. I understand and agree that from time to time the bank may require me to submit to a drug and/or alcohol test, and that refusal to submit to such test will be grounds for refusal to hire me or termination of my employment if already hired. I agree that, if my position requires me to use a motor vehicle, I will maintain a safe driving record, both on and off the job, and a valid appropriate driver’s license, as a condition of my continued employment. I further agree that, upon request at any time, I will submit to a physical examination by a bank physician, as a condition of my initial or continued employment. Any such testing or examination will be at the bank’s expense, and in compliance with applicable law. I understand and agree that all disputes between IBC and me concerning my application for employment, my employment, if any, or the termination thereof will be submitted to arbitration in accordance with the IBC Dispute Resolution Policy and the National Rules for the Resolution of Employment Disputes of the American Arbitration Association which are in effect at the time the dispute arises. If I am employed by the bank, then regardless of the stated frequency of payment of my wages or salary (e.g., per month, per year), the bank may terminate my employment at any time, with or without cause or prior notice, and no promises to the contrary shall be binding upon the Bank unless committed to writing in an otherwise enforceable agreement signed by the appropriate bank official. If employed, I agree to comply with all rules and regulations of the bank at present and as modified from time to time during my employment including, without limitation, the agreement to arbitrate any disputes between me and the bank. I agree to participate in IBC’s interview panel and activity interview. I understand and consent to the use of the videotaping by IBC. I understand that the information and videotape is for interviewing purposes only and that my name and image will not be used for any other purpose. I relinquish any rights to the videotape and understand the videotape may be copied and used by IBC. I understand that I can elect not to participate in this interview process. I agree to immediately raise any concerns or areas of discomfort with the HR Manager.

APPLICANT’S SIGNATURE ______________________________________________________________________________________________________________

IBC-0280-01 REVISED 03/2015

I certify that the foregoing statements are true, complete and correct. I understand that the falsification or material omission of any of the information requested

on this form or during my pre-employment interview will result in rejection of this application or, if discovered during my employment, may result in my dismissal.

I authorize each person and entity identified above to disclose to the bank any and all information they may have concerning me, including my past performance,

employment record and character. I expressly release these persons from any and all liability for furnishing responses to these inquiries.

I authorize the bank to investigate my credit, my employment and personal background. If I am denied employment as a result of a credit report, the bank will

inform me of this reason and the name and address of the reporting agency that supplied the report.

I understand and agree that from time to time the bank may require me to submit to a drug and/or alcohol test, and that refusal to submit to such test will be

grounds for refusal to hire me or termination of my employment if already hired.

I agree that, if my position requires me to use a motor vehicle, I will maintain a safe driving record, both on and off the job, and a valid appropriate driver’s license,

as a condition of my continued employment.

I further agree that, upon request at any time, I will submit to a physical examination by a bank physician, as a condition of my initial or continued employment.

Any such testing or examination will be at the bank’s expense, and in compliance with applicable law.

I understand and agree that all disputes between IBC and me concerning my application for employment, my employment, if any, or the termination thereof will be

submitted to arbitration in accordance with the IBC’s Open Door Policy, a copy of which is available for my review prior to signing this application. I further agree that

I will not bring a claim or a dispute against IBC in a representative, collective or class actions, nor will I join such an action and I waive my right to do so in the future.

If I am employed by the bank, then regardless of the stated frequency of payment of my wages or salary (e.g., per month, per year), the bank may terminate my

employment at any time, with or without cause or prior notice, and no promises to the contrary shall be binding upon the Bank unless committed to writing in an

otherwise enforceable agreement signed by the appropriate bank official. If employed, I agree to comply with all rules and regulations of the bank at present and

as modified from time to time during my employment including, without limitation, the agreement to arbitrate any disputes between me and the bank.

I agree to participate in IBC’s interview panel and activity interview. I understand and consent to the use of the videotaping by IBC. I understand that the information

and videotape is for interviewing purposes only and that my name and image will not be used for any other purpose. I relinquish any rights to the videotape and

understand the videotape may be copied and used by IBC. I understand that I can elect not to participate in this interview process. I agree to immediately raise

any concerns or areas of discomfort with the HR Manager.

REVISED 03/2015

INTERNATIONAL BANCSHARES CORPORATION

APPLICATION FOR EMPLOYMENT

PLEASE PRINT OR TYPE

THE INFORMATION GIVEN ON THIS FORM IS FOR USE BY THE INTERNATIONAL BANCSHARES CORP. ANSWER EACH QUESTION FULLY AND ACCURATELY. THE USE OF THIS FORM DOES NOT INDICATE THAT THERE ARE ANY POSITIONS OPEN AND DOES NOT IN ANY WAY OBLIGATE IBC. THIS APPLICATION WILL BE KEPT ACTIVE FOR 60 DAYS. INTERNATIONAL BANCSHARES CORPORATION IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER.

IDEN

TIFI

CA

TIO

N NAME (LAST, FIRST, MIDDLE) APPLICATION DATE

ADDRESS (INCLUDE ZIP) CITY STATE ZIP PHONE NUMBER (INCLUDE AREA CODE)

HOME WORK OR

ARE YOU AUTHORIZED TO WORK IN THE U.S.?

❑ Yes ❑ No EVER APPLIED OR BEEN EMPLOYED BY A IBC BANCORPORATION MEMBER? ❑ Yes ❑ No IF YES, WHERE WHEN

PER

SON

AL

POSITION DESIRED EMPLOYMENT DESIRED ❑ Full Time ❑ Regular ❑ Part Time ❑ Temporary

SALARY DESIRED DATE AVAILABLE WILL YOU PERFORM SHIFT WORK? ❑ Yes ❑ No

LIST OFFICE AND COMPUTER PROGRAM SKILLS WHO REFERRED YOU TO IBC?

❑ FRIEND WHO WORKS AT IBC?

NAME

❑ RELATIVE WHO WORKS AT IBC?

NAME

❑ NEWSPAPER

NAME OF NEWSPAPER

❑ AGENCY - NAME

❑ OTHER - EXPLAIN

EMAIL ADDRESS

FOREIGN LANGUAGE SKILLS

SPEAK READ WRITE HAVE YOU EVER BEEN BONDED?

❑ Yes ❑ No HAVE YOU EVER BEEN REFUSED A BOND?

❑ Yes ❑ No

EDU

CA

TIO

N

SCHOOL NAME & LOCATION

MAJOR / MINOR

DEGREE GRADE AVERAGE

OVERALL MAJOR HIGH SCHOOL * DIPLOMA?

❑Yes ❑ No COLLEGE ** ❑Yes ❑ No GRADUATE OTHER (INCLUDE SPECIAL TRAINING, COURSES & APPRENTICESHIPS COMPLETED)

EXPLAIN ANY PLANS YOU HAVE FOR FURTHER STUDY * IF NOT A HIGH SCHOOL GRADUATE, INSERT NUMBER OF SCHOOL YEARS COMPLETED

* * IF NO DEGREE HAS BEEN OBTAINED, INSERT NUMBER OF COLLEGE CREDIT HOURS COMPLETED

REF

EREN

CES

PERSONS FAMILIAR WITH YOUR WORK OR ACADEMIC BACKGROUND NAME POSITION & COMPANY LOCATION PHONE

FRIENDS OR RELATIVES WHO ARE EMPLOYEES OF THIS ORGANIZATION OR ANY BANK NAME RELATIONSHIP POSITION & COMPANY LOCATION

IBC-0280-01 REVISED 03/2015

EM

PLO

YMEN

T D

ATA

LIST OF EMPLOYERS BEGINNING WITH PRESENT OR MOST RECENT


THIS EMPLOYER? Yes No REASON(S) FOR LEAVING DESCRIBE YOUR PRINCIPAL RESPONSIBILITIES







OTHER EMPLOYERS WITHIN THE PAST 10 YEARS, IF APPLICABLE

NAME OF EMPLOYER

DATES POSITION FROM TO

I certify that the foregoing statements are true, complete and correct. I understand that the falsification or material omission of any of the information requested on this form or during my pre-employment interview will result in rejection of this application or, if discovered during my employment, may result in my dismissal. I authorize each person and entity identified above to disclose to the bank any and all information they may have concerning me, including my past performance, employment record and character. I expressly release these persons from any and all liability for furnishing responses to these inquiries. I authorize the bank to investigate my credit, my employment and personal background. If I am denied employment as a result of a credit report, the bank will inform me of this reason and the name and address of the reporting agency that supplied the report. I understand and agree that from time to time the bank may require me to submit to a drug and/or alcohol test, and that refusal to submit to such test will be grounds for refusal to hire me or termination of my employment if already hired. I agree that, if my position requires me to use a motor vehicle, I will maintain a safe driving record, both on and off the job, and a valid appropriate driver’s license, as a condition of my continued employment. I further agree that, upon request at any time, I will submit to a physical examination by a bank physician, as a condition of my initial or continued employment. Any such testing or examination will be at the bank’s expense, and in compliance with applicable law. I understand and agree that all disputes between IBC and me concerning my application for employment, my employment, if any, or the termination thereof will be submitted to arbitration in accordance with the IBC Dispute Resolution Policy and the National Rules for the Resolution of Employment Disputes of the American Arbitration Association which are in effect at the time the dispute arises. If I am employed by the bank, then regardless of the stated frequency of payment of my wages or salary (e.g., per month, per year), the bank may terminate my employment at any time, with or without cause or prior notice, and no promises to the contrary shall be binding upon the Bank unless committed to writing in an otherwise enforceable agreement signed by the appropriate bank official. If employed, I agree to comply with all rules and regulations of the bank at present and as modified from time to time during my employment including, without limitation, the agreement to arbitrate any disputes between me and the bank. I agree to participate in IBC’s interview panel and activity interview. I understand and consent to the use of the videotaping by IBC. I understand that the information and videotape is for interviewing purposes only and that my name and image will not be used for any other purpose. I relinquish any rights to the videotape and understand the videotape may be copied and used by IBC. I understand that I can elect not to participate in this interview process. I agree to immediately raise any concerns or areas of discomfort with the HR Manager.

APPLICANT’S SIGNATURE ______________________________________________________________________________________________________________

IBC-0280-01 REVISED 03/2015

I certify that the foregoing statements are true, complete and correct. I understand that the falsification or material omission of any of the information requested

on this form or during my pre-employment interview will result in rejection of this application or, if discovered during my employment, may result in my dismissal.

I authorize each person and entity identified above to disclose to the bank any and all information they may have concerning me, including my past performance,

employment record and character. I expressly release these persons from any and all liability for furnishing responses to these inquiries.

I authorize the bank to investigate my credit, my employment and personal background. If I am denied employment as a result of a credit report, the bank will

inform me of this reason and the name and address of the reporting agency that supplied the report.

I understand and agree that from time to time the bank may require me to submit to a drug and/or alcohol test, and that refusal to submit to such test will be

grounds for refusal to hire me or termination of my employment if already hired.

I agree that, if my position requires me to use a motor vehicle, I will maintain a safe driving record, both on and off the job, and a valid appropriate driver’s license,

as a condition of my continued employment.

I further agree that, upon request at any time, I will submit to a physical examination by a bank physician, as a condition of my initial or continued employment.

Any such testing or examination will be at the bank’s expense, and in compliance with applicable law.

I understand and agree that all disputes between IBC and me concerning my application for employment, my employment, if any, or the termination thereof will be

submitted to arbitration in accordance with the IBC’s Open Door Policy, a copy of which is available for my review prior to signing this application. I further agree that

I will not bring a claim or a dispute against IBC in a representative, collective or class actions, nor will I join such an action and I waive my right to do so in the future.

If I am employed by the bank, then regardless of the stated frequency of payment of my wages or salary (e.g., per month, per year), the bank may terminate my

employment at any time, with or without cause or prior notice, and no promises to the contrary shall be binding upon the Bank unless committed to writing in an

otherwise enforceable agreement signed by the appropriate bank official. If employed, I agree to comply with all rules and regulations of the bank at present and

as modified from time to time during my employment including, without limitation, the agreement to arbitrate any disputes between me and the bank.

I agree to participate in IBC’s interview panel and activity interview. I understand and consent to the use of the videotaping by IBC. I understand that the information

and videotape is for interviewing purposes only and that my name and image will not be used for any other purpose. I relinquish any rights to the videotape and

understand the videotape may be copied and used by IBC. I understand that I can elect not to participate in this interview process. I agree to immediately raise

any concerns or areas of discomfort with the HR Manager.

This page intentionally left blank.

Name

Position Desired

Are you looking for Part Time Full Time

*Are you currently attending school? Yes No

*Do you plan to attend school? Yes No

Monday Monday

Tuesday Tuesday

Wednesday Wednesday

Thursday Thursday

Friday Friday

Saturday Saturday

Sunday Sunday

How far are you willing to travel?

What is the closest branch to you?

*If you are currently enrolled in school or plan to attend school, please list your

school schedulePlease list your AVAILABILITY below

Schedule Availability

Page 1 of 8 Revised 03/2015


of 8 Revised 03/2015

OFFICE SKILLS INFORMATION SHEET FOR APPLICANTS To all applicants for office positions at IBC: Please complete the following questionnaire regarding your office skills. Please answer all questions and note you may be tested on these skills. Word Speed _________ Are you able to format business letter? Yes No Are you able to create envelopes? Yes No Are you able to insert tables into a Word document Yes No Excel Have you created spreadsheets which include formulas? Yes No Are you able to add a header to and excel document? Yes No Are you able to hide rows/columns in an excel document? Yes No Are you able to sort data on a spreadsheet? Yes No PowerPoint Are you able to create new presentations? Yes No Are you able to change the background of your presentations? Yes No Are you able to add Speaker notes? Yes No Are you able to insert and modify graphics? Yes No Ten Key Calculator Level of experience? Minimal Moderate High


Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005

Expires

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.i 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 willchoose 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 Autism Bipolar disorder Post-traumatic stress disorder (PTSD)Deafness Cerebral palsy Major depression Obsessive compulsive disorderCancer HIV/AIDS Multiple sclerosis (MS) Impairments requiring the use of a wheelchairDiabetes Schizophrenia Missing limbs or Intellectual disability (previously called mentalEpilepsy Muscular partially missing limbs retardation)

dystrophy

Please check one of the boxes below:

______________________________ ____________________

Your Name Today’s Date

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

NO, I DON’T HAVE A DISABILITY

I DON’T WISH TO ANSWER

Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005

Expires

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.

i 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.

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Invitation to Self-Identify as a Protected Veteran

This employer is a Government contractor 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: (1.) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

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.

Protected veterans may have additional rights under USERRA - the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll-free, at: 1-866-4-USA-DOL. 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.

[ ] I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE.

[ ] I AM NOT A PROTECTED VETERAN.

__________________________________________ ____________________________ NAME DATE


REVISED 03/2015

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VOLUNTARY DISCLOSURE OF AFFIRMATIVE ACTION INFORMATION

Declining to respond will not affect your application. Any information that you provide will be held in confidence and will not be shared with hiring officials. It will be handled in accordance with Executive Order 11246, the Veteran's Readjustment Assistance Act, the Veteran's Opportunities Act, Sections 503 and 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act and any other applicable state and local laws.

Name of Applicant:

Position Applied For:

(Please Print)

Gender: Male Female

Ethnic Category: Please check only one box.

INTERNATIONAL BANCSHARES CORP. AND ITS MEMBER ORGANIZATIONS ARE EQUAL OPPORTUNITY EMPLOYERS.

Whether or not the information above is provided, please sign and date this form.

Signature of Applicant Date

Hispanic or Latino, Regardless of Race: All persons of Mexican, Puerto Rican, Cuban, Central American, South American, or other Spanish culture or origin

All other Categories Not Hispanic or Latino

Two or More Races

American Indian or Alaskan Native: Persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition

Black or African American: Persons having origins in any of the Black racial groups in Africa

White: Persons of Canadian, German, Italian, Polish, and other similar descent

Asian: Persons of Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other similar descent

Native Hawaiian or Other Pacific Islander: Persons of Native Hawaiian, Guamanian, Chamorro, Samoan, and other similar descent


REVISED 03/2015


REQUIRED INFORMATION FOR CRIMINAL HISTORY CHECK AND/OR DRIVING RECORDS CHECK PLEASE PRINT LEGIBLY IN BLACK INK

Name of Applicant/Employee:

(Last, First, Middle)

Date of Birth: Social Security Number:

Have you ever been convicted of, pled guilty or no lo contendere (no contest), or received deferred adjudication relating to any charge?

YES NO

1. CRIMINAL HISTORY CHECK

If you have any criminal convictions, please provide the date, place and nature of conviction(s) here:

CURRENT AND FORMER ADDRESSES:

(Please provide the requested information for all places you have lived from age 18 to present.

City/State/Zip County (if known) Years Lived There

2. DRIVING RECORD CHECK: (if driving is a requirement of the position, Applicant/Employee must complete the

following)

Driver’s License Number: State: Expiration Date:

Have you ever held a driver’s license in any other state? YES NO

If yes, what state(s)? Dates Held:

I acknowledge that I have received a copy of a "Summary of Your Rights under the Fair Credit Reporting Act." I certify that the information given by me in the employment application process and stated on this form is true and correct to the best of my knowledge. I understand and agree that any omission or misrepresentation by me shall be grounds for denial of employment, or, if hired, termination of my employment.

Conviction will not necessarily bar employment. Consideration will be given to the nature of the crime, its seriousness, time since conviction, age at time of offense, rehabilitation, and position for which you are applying.

Signature of Applicant/Employee Date

Have you been known by any other names? YES NO

If yes, please list:




FAIR CREDIT REPORTING ACT DISCLOSURE & AUTHORIZATION

DISCLOSURE

This document is to serve as NOTICE that International Bank of Commerce. ("IBC") is authorized to request for all applicants and employees a consumer report or an investigative consumer report from a consumer reporting agency as provided for and defined by the Fair Credit Reporting Act. A consumer report may include, but is not limited to, any written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing your eligibility for employment purposes. It may also include, but not be limited to, credit information reports, criminal history reports and driving history records. An investigative consumer report is a consumer report in which information regarding your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your neighbors, friends, or associates reported on or with others with whom you are acquainted or who may have knowledge concerning any such items of information. You have the right to make a written request to IBC within a reasonable period of time of receipt of this disclosure for additional information concerning the nature and scope of this investigation. I acknowledge that I am bound by the Policy for Dispute Resolution (the "Arbitration Policy"), which includes an agreement to arbitration any disputes relating to my application for employment or my employment if ultimately hired. I acknowledge that a copy of the Arbitration Policy has been made available for my review. I also understand that neither this document nor my application constitutes a contract of any kind and my employment is at will. Included with this Disclosure and Authorization is a written summary of your rights as a consumer under the Fair Credit Reporting Act. Please read it carefully and familiarize yourself with your rights under the law.

AUTHORIZATION AND RELEASE

By signing below, I authorize International Bank of Commerce to obtain a consumer report and/or an investigative consumer report about me from a consumer reporting agency and to consider this information when making decisions regarding my employment or prospective employment at International Bank of Commerce. I understand and acknowledge that International Bank of Commerce may obtain additional consumer reports at any time during the course of my employment. If hired, this authorization shall remain on file and shall serve as ongoing authorization for International Bank of Commerce to procure consumer reports at any time during my employment period; I agree to execute additional Disclosure and Release forms at any time requested during my employment. I also acknowledge that I have received a written summary of my rights as a consumer under the Fair Credit Reporting Act. I further release International Bank of Commerce and any entity they contact from any and all liability that may result from the release and/or use of such information for employment purposes.

Printed Name of Applicant/Employee Signature of Applicant/Employee Date


Attention Applicant: Please keep this form for your information.

Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.

A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of

information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.

You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credi t, insurance, or employment — or to take another adverse action against you — must tell you, and must give you the name, address, and phone number of the agency that provided the information.

You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

a person has taken adverse action against you because of information in your credit report;

you are the victim of identify theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. In addition, by

September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit for additional information.

You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures.

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit.

You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-5678688).

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more information, visit www.ftc.govicredit.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are: TYPE OF BUSINESS: CONTACT: Consumer reporting agencies, creditors and others not listed below Federal Trade Commission: Consumer Response Center - FCRA

Washington, DC 20580 1-877-382-4357

National banks, federal branches/agencies of foreign banks (word "National" or initials "NA" appear in or after bank's name)

Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC 20219 800-613-6743

Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks)

Federal Reserve Consumer Help (FRCH) P 0 Box 1200 Minneapolis, MN 55480 Telephone: 888-851-1920 Website Address: www.federalreserveconsumerhelp.qov Email Address: ConsumerHelp(FederalReserve.gov

Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name)

Office of Thrift Supervision Consumer Complaints Washington, DC 20552 800-842-6929

Federal credit unions (words "Federal Credit Union" appear in institution's name)

National Credit Union Administration 1775 Duke Street Alexandria, VA 22314 703-519-4600

State-chartered banks that are not members of the Federal Reserve System

Federal Deposit Insurance Corporation Consumer Response Center, 2345 Grand Avenue, Suite 100 Kansas City, Missouri 64108-2638 1-877-275-3342

Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission

Department of Transportation , Office of Financial Management Washington, DC 20590 202-366-1306

Activities subject to the Packers and Stockyards Act, 1921 Department of Agriculture Office of Deputy Administrator - GIPSA Washington, DC 20250 202-720-7051

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