APPLICATION FOR EMPLOYMENT


Chemung Canal Trust Company & CFS Group, Inc., subsidiaries of Chemung Financial Corporation, and Capital Bank, a division of Chemung Canal Trust Company, are affirmative action/equal opportunity employers and are committed to recruiting and selecting applicants for employment without discrimination. The Company will not discriminate on the basis of race, color, age, religious creed, sex, sexual orientation, marital status, national origin, ancestry, veteran status, disability, genetic information or any other characteristic protected by federal state or local law. If you require reasonable accommodation to complete this application and/or any other aspect of the employment application process, or have any other questions, please contact Human Resources at (607) 737-3770, or toll-free at (800) 836-3711.

Please fill out (electronically or in written format) and submit via one of the following options:
- complete application and submit from this page
- fax to (607)735-4024
- e-mail to HR@chemungcanal.com
- bring the application to any one of our branches
- or mail to Chemung Canal Trust Company, ATTN : Human Resources,
                     P. O. Box 1522, Elmira, NY 14902.

* indicates a required field


Date of Application
*Position(s) Applied For
Location/Branch
Location/Branch
*Last Name
*First Name
*Middle Initial
*Street
*City, State Zip ,
E-Mail Address
*Phone Number
*If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S?
Note: Federal law requires that you provide documents which verify your identity and your eligibility for employment in the U.S. As a condition of employment, you are required to provide such documentation and to sign a form establishing that you are lawfully able to work in the U.S.
*Have you been employed here before?
If Yes, Dates Employed
*Desired hours - Full Time Part Time Temporary
*Date available for work?
Do you have any friends or relatives employed by the company? If yes, please provide their names and relationship to you.
*Are you over the age of 18?
If no, please state age -
 
Describe any skill and aptitudes relevant to the position applied for
 
EMPLOYMENT HISTORY -
List below all present and past employers starting with your most recent employer.
*May we contact your current employer?
 
Employer Dates
Address From:
Job Title To:
Supervisor Hourly Rate/Salary
Supervisor Phone No. Start:
Supervisor E-Mail Final:
Work Performed
Reason for Leaving
 
Employer Dates
Address From:
Job Title To:
Supervisor Hourly Rate/Salary
Supervisor Phone No. Start:
Supervisor E-Mail Final:
Work Performed
Reason for Leaving
 
Employer Dates
Address From:
Job Title To:
Supervisor Hourly Rate/Salary
Supervisor Phone No. Start:
Supervisor E-Mail Final:
Work Performed
Reason for Leaving
 
Employer Dates
Address From:
Job Title To:
Supervisor Hourly Rate/Salary
Supervisor Phone No. Start:
Supervisor E-Mail Final:
Work Performed
Reason for Leaving
 
Account for all periods of unemployment by describing below.
 
*Have you ever been convicted of a felony?
 
If yes, describe in full including dates:
 
*Are you able to perform all of the essential functions of the job for which you are applying, with or without reasonable accommodation?
 
If no, please explain
 
EDUCATION -
 
  Name and Address of School Course of Study Total Years of Study Degree/ Diploma
High School
Undergraduate / College
Graduate / Professional
Other (Please Specify)
 
List any seminars, classes or other education which may help qualify you for this position:
 
 
EMPLOYMENT REFERENCES -
List below three persons, not related to you, who have knowledge of your work performance:
Name
Occupation
Company
Address
City, State Zip ,
Telephone
E-Mail
Relationship & Years Aquainted
 
Name
Occupation
Company
Address
City, State Zip ,
Telephone
E-Mail
Relationship & Years Aquainted
 
Name
Occupation
Company
Address
City, State Zip ,
Telephone
E-Mail
Relationship & Years Aquainted

AUTHORIZATION AND ACKNOWLEDGEMENT

Please read carefully, and sign the statement below (if completing online, print and sign):

I understand and state that:

1. All statements made by me on this application are true and complete to the best of my knowledge and that I understand that misrepresentations or omissions may be cause for rejection, or may be cause for subsequent dismissal if hired.

2. In processing my application for employment, the Company may verify all the information provided by me including, but not limited to, my prior employment, education, character, general reputation, personal characteristics, credit history, and driving record. I authorize any request that all of my present and former employers, and those individuals I have listed as personal references, furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information.

3. If employed, I will comply with all policies, rules, regulations and procedures of the Company. I understand that, if hired, my employment with the Company will be at-will and can be terminated with or without cause or notice, at any time, at the option of either the Company, or myself. I also understand that no Company employee, except the President, can sign a contract of employment with me on behalf of the Company.

4. This application will be given every consideration, but our receipt of it does not imply that you will be offered employment. This Company, at its own expense, arranges for a surety bond for each of its employees. Unless your background is acceptable to a surety company (not affected by race, color, religion, sex, national origin, age, disability, veteran status or a status within any protected group), it will be difficult to secure this bond and this Company may be unable to offer you employment.

5. The Company will consider this application active for 90 days. After the 90 days, if a position becomes available, you will need to apply again.

*I hereby acknowledge that I have read and understand each of the above statements.

 

Voluntary Self-Identification

The following information is being requested solely for affirmative action efforts. The information that you provide will not be used in our selection decision and will be treated as personal and confidential. Your submission of this information is optional. Failure to provide this information will not be used against you.

*Date
*Last Name
*First Name
Middle Initial
Position(s) Applied For
Referred By
I understand the reason for this request for voluntary self-identification as stated above and choose to decline.
I understand the reason for this request for voluntary self-identification as stated above and will supply the requested information.

 
GENDER -
Female Male
 
RACE / ETHNICITY -





 
VETERAN STATUS -
If you are a veteran, please check any boxes that apply below. Once again, this information is voluntary. The information will not be used in our selection process.
Disabled Veteran

(1) 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 (2) A person who was discharged or released from active duty because of a service-connected disability.

Recently Separated Veteran

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 service.

Date Separated
Armed Forces Service Medal Veteran

Any 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.

Other Protected Veteran

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.


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