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Application for Employment

We are pleased that you are interested in applying for a position with our Bank. Bath Savings Institution is an Equal Employment Opportunity/Affirmative Action Employer. This Institution does not discriminate in hiring or employment on the basis of race, color, national origin or ancestry, religion, sex, sexual orientation, pregnancy, genetics, age, disability, concerted activity of employees on terms of employment, assertion of a workers’ compensation claim, service in the uniformed services, or veteran’s status. No question on this form, or additional documents provided, is intended to secure information to be used for such discrimination.

We will give this application every consideration. However, in accepting it, this Institution makes no commitment of employment to the applicant.

Required fields are identified with a star ()

Basic Information

Please Include Area Code
Please Include Area Code

Current Addressrequired

Previous Address

Have you previously been employed by Bath Savings Institution?required
Do you have a relative(s) currently employed by Bath Savings Institution?required

Work History

Start with your present or most recent job. List self-employment, summer and part-time jobs. Include employers located in the United States only.

Work History: 1 of 3
Dates Employed

Work History: 2 of 3
Dates Employed

Work History: 3 of 3
Dates Employed

Authorization For Release of Information & Release and Waiver of Claims

I hereby request and authorize my current employer and/or my former employer(s) to furnish Bath Savings Institution with information from my personnel records with regard to:
(all fields are requiredrequired)

By making this request I hereby release my current and/or former employer(s), it’s agents and/or employees, of any and all claims and liabilities of any kind whatsoever arising out of compliance with this request.

Signing this document electronically constitutes my written signature and agreement to the Authorization For Release of Information & Release and Waiver of Claims.

Office Equipment/Technology

Check the following office equipment which you are able to operate.


High School / GED

Business School


Graduate Work

Other (Describe)

Are you planning to pursue further studies?

Interests/Community Activities

Please use the space below to describe your interest in the financial/banking industry and the skills and aptitudes that you feel qualify you for a position with this institution. Please include civic and community activities, and professional activities in which you participate.


Please list the names, addresses and telephone numbers of three personal references, excluding relatives, former employers and former supervisors.


Have you ever been convicted of any crime involving, but not limited to, dishonesty, breach of trust, theft, bribery, fraud, bank fraud, forgery, larceny, extortion, embezzlement, or any other type of financial crime?

Certification & Assent

I hereby certify that the statements I have made are true, and if I am subsequently employed by Bath Savings Institution I may be required to take a physical examination by the physician of the Bank’s choice. I understand that employment and continued employment may be conditional upon securing and retaining a surety bond, issued by a company selected by the Bank. I also understand that if employed, Bath Savings Institution at all times reserves and has the right to determine rate of pay or reassign duties, and to terminate employment at will as the sole judgment of the Bank may indicate.

I hereby acknowledge that I have read the above statements and understand the same.

By signing this document electronically I hereby give my certification and assent.

Disclosure Notice to Applicants as required by the Fair Credit Reporting Act

In connection with your employment application, a consumer credit report, and/or an investigative consumer report, including information with respect to your character, general reputation, mode of living and personal characteristics, whichever are applicable, may be made.

You have a right to request and receive a written statement explaining the nature and scope of any investigation that is requested with respect to you, as well as the name, address and telephone number of the nearest unit designated to handle inquiries of each consumer reporting agency issuing an investigative consumer report about you. Bath Savings Institution will provide this information to you within five (5) business days of receiving your request. You also have the right to request and promptly receive copies of any investigative consumer report about you from any credit reporting agency issuing such a report.

Such requests should be mailed to:

Bath Savings Institution
P.O. Box 548
105 Front Street
Bath, ME 04530
Attn: Susan G. Carleton
Senior Vice President/Human Resources

Printable Notice to Applicants (PDF)

Bath Savings Institution Investigative Consumer Report Authorization Form

I hereby authorize Bath Savings Institution, its subsidiaries, affiliates, employees and agents, including TransUnion, to make inquiry of and request information from any individuals, present and former employers, schools and colleges, credit bureaus, criminal investigation bureaus, and any other entities that may possess information concerning me or that may be custodians of records relating to me. I authorize the described sources to release information requested, including salary data and subjective evaluations.

I hereby release and agree to hold harmless Bath Savings Institution, its parent companies, subsidiaries, affiliates, and/or related companies, and each and all of its current or former agents, officers, directors, employees, partners, shareholders, representatives, successors and assigns, from any and all liability, claims or damages that may be directly or indirectly result from the solicitation, use, disclosure or release of any of the above referenced information. In addition, I hereby release and agree to hold harmless any and all individuals and entities who provide any information concerning me, whether orally or in writing, in response to a request for such information from Bath Savings Institution.

By signing this authorization electronically I hereby authorize Bath Savings Institution to the above.

Para informacion en espanol, visite 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 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 credit, 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 identity 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 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 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
  • 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 (1-888-567-8688).
  • 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

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
National Banks, Federal branches/agencies of foreign banks (word “National” or initials “N.A.” in or after bank’s name.) Office of the Comptroller of the Currency Compliance Management
Mail Stop 6-6
Washington, DC 20219
Federal Reserve System member banks (except national Banks, and federal branches/agencies of foreign banks.) Federal Reserve Consumer Help (FRCH)
P O Box 1200
Minneapolis, MN 55480
Telephone: 888-851-1920
Website Address:
Email Address:
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
Federal credit unions (words “Federal Credit Union” appear in institution’s name) National Credit Union Administration
1775 Duke Street
Alexandria, VA 22314
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
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
Activities subject to the Packers and Stockyards Act, 1921 Department of Agriculture
Office of Deputy Administrator - GIPSA
Washington, DC 20250

Printable Summary of Rights (PDF)

EEO-1 / Affirmative Action / Veteran Status Self-Identification Form

Bath Savings Institution is subject to the recordkeeping and reporting requirements of government regulations for equal employment opportunity, affirmative action (EEO/AA) and employment of veterans including, but are not limited to, affirmative action responsibilities as required under Executive Order 11246, Section 503 of the Rehabilitation Act of 1973, section 4212 of the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA) of 1974 and the Veterans Employment Opportunities Act (VEOA) of 1998. We must track our applicants by gender, race/ethnicity and veteran’s status; and report to the Equal Employment Opportunity Commission (EEO-1) and the U.S. Department of Veterans Affairs each year. When reported, the data will not identify any specific individual.

Completion of Section 2 of this form is voluntary and will not affect your opportunity for employment or terms/conditions of employment. The confidential information on this form will remain within the Human Resources Department and will be used for EEO-1/Affirmative Action/Veteran Status reporting purposes only. This form will be will be kept separate from all other personnel records.

Section 1 - Required Information:

Position applied for:

Section 2 - Voluntary Information:

Gender (Please check one)


Are you Hispanic or Latino?


(IMPORTANT — Only complete this section if you checked “No, I am not Hispanic or Latino” in the Ethnicity section above.)

What is your race? (Please select ONE of the following categories):

Veteran Status

Are you a...

Voluntary Self-Identification of Disability

OMB Control Number: 1250-0005

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.1 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:

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.

1 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

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.