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First Name * Required

Middle Name Required

Last Name * Required

Email Address * Required

Confirm Email Address * Required

Address Line 1 * Required

Address Line 2

City * Required

State * Required Please select a state Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Northern Mariana Islands Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington U.S. Virgin Islands West Virginia Wisconsin Wyoming

Zip * Required

Phone Number *Required

Applicant Information

Please answer all the questions.

Are you Applying for a Full time or Part Time * Required Select Full Time Part Time

List Previous Street Address 1 if at present address less than 5 years Required

City 1 Required

State 1 Required Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip 1 Required

How long at this address in years Required

Street Address 2 Required

City 2 Required

State Required Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Required

How long at this address in years Required

Job Information

Please answer all the questions.

Position Applied for * Required

Salary Requirements Required

$

How were you referred to Pilgrim Bank? Required

Date Available for Work Required

Have you previously been employed with Pilgrim Bank? Required Select Yes No

(Dates & Locations) Required

Are you 18 years of age or older? Required Select Yes No

Are you eligible to work in the United States? Required Select Yes No

Have you ever been convicted, pled guilty, pled no contest, or received deferred adjudication for (1) a felony criminal offense or (2) any criminal offense involving dishonesty, breach of trust including robbery, theft, embezzlement, forgery, perjury, money laundering, or tax evasion? * Required Select Yes No

If Yes Please Explain * Required

Have you signed any agreement with any other employer that might restrict you from working at Pilgrim Bank? * Required Select Yes No

If yes, please explain. Note: You may be required to furnish a copy of this agreement * Required

Education

High School

City Required

State Required Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Course of Study Required

No. Years Completed Required

Education

Technical/Vocational

City Required

State Required Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Course of Study Required

No. Years Completed Required

Graduate/Degree Required

Education

College/University

City Required

State Required Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Course of Study Required

No. Years Completed Required

Graduate/Degree Required

Education

Graduate Study

City Required

State Required Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Course of Study Required

No. Years Completed Required

Graduate/Degree Required

Education

Other

City Required

State Required Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Course of Study Required

No. Years Completed Required

Graduate/Degree Required

Qualifications

List professional or technical licenses, registrations, certifications:

Qualification 1 Required

Qualification 2 Required

Qualification 3 Required

Honors Received

Please answer all the questions.

Honor 1 Required

Honor 2 Required

Honor 3 Required

Organizations

To what organizations, fraternal, social, educational, professional and others do you belong (exclude those which may disclose race, age, gender, disability, color, religion, sexual orientation, national origin, or membership in a labor union or labor union training program)?

Organization 1 Required

Organization 2 Required

Organization 3 Required

Are you planning to pursue further education? * Required Select Yes No

If so * Required Select Day Night

Military

Please answer all the questions.

Veteran of the U.S. Military Required Select Yes No

If yes, what branch Required

Date of Discharge Required

Training Required

Employment History 1

Starting with the present or most recent employer, list all previous employers, including self-employment, part-time and military service.

Company Name Required

Address Required

Date From Required

Date To Required

Supervisor’s Name Required

Reason for Leaving Required Select Resignation Termination Laid off/Reduction in Force

Position Name Required

Major Duties Required

Salary Required

$

Names of relatives or friends employed by Pilgrim Bank Required

If presently employed, why do you desire to change jobs? Required

If you are now employed, may we contact your present employer? Required Select Yes No

Employment History 2

Please answer all the questions.

Company Name Required

Address Required

Date From Required

Date To Required

Supervisor’s Name Required

Reason for Leaving Required Select Resignation Termination Laid off/Reduction in Force

Position Name Required

Major Duties Required

Salary Required

$

Employment History 3

Please answer all the questions.

Company Name Required

Address Required

Date From Required

Date To Required

Supervisor’s Name Required

Reason for Leaving Required Select Resignation Termination Laid off/Reduction in Force

Position Name Required

Major Duties Required

Salary Required

$

Employment History 4

Please answer all the questions.

Company Name Required

Address Required

Date From Required

Date To Required

Supervisor’s Name Required

Reason for Leaving Required Select Resignation Termination Laid off/Reduction in Force

Position Name Required

Major Duties Required

Salary Required

$

Skills

Please answer all the questions.

Typing WPM Required

Teller Machine Required Select Yes No

Calculator Required Select Yes No

10-Key by Touch Required Select Yes No

Personal Computer Required Select Yes No

Excel Required Select Yes No

Word Required Select Yes No

PowerPoint Required Select Yes No

Other Microsoft Product Required

Other Skill 1 Required

Other Skill 2 Required

Other Skill 3 Required

Reference 1

Please provide 3 References

Name * Required

Address Required

Telephone No. * Required

Relationship * Required

Years Known * Required

Reference 2

Please answer all the questions.

Name * Required

Address Required

Telephone No. * Required

Relationship * Required

Years Known * Required

Reference 3

Please answer all the questions.

Name * Required

Address Required

Telephone No. * Required

Relationship * Required

Years Known * Required

Government Self-Identification Form

Please answer all the questions.

Position(s) Applied For * Required

Location of Position * Required Select Clarendon Decatur Electra Holliday Iowa Park Mt Pleasant Pittsburg Sulphur Springs Vernon Wellington Wichita Falls Windthorst

Referral Source * Required Select State Employment Agency Friend Relative Walk-In Company Website Other

If other Please explain * Required

Gender * Required Select Male Female Do not wish to answer

Are you Hispanic or Latino * Required Select Yes, I am Hispanic or Latino No, I am not Hispanic or Latino I Do Not Wish to Answer

Do you wish to Provide your Race * Required Select I Do Not Wish to provide My Race I Do Wish to provide My Race

White * Required Select Yes No

Black or African American * Required Select Yes No

American Indian/Alaskan Native * Required Select Yes No

Asian * Required Select Yes No

Native Hawaiian or Other Pacific Islander * Required Select Yes No

Voluntary Self-Identification of Disability

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disabilityAlcohol or other substance use disorder (not currently using drugs illegally) • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS • Blind or low vision • Cancer (past or present) • Cardiovascular or heart disease • Celiac disease • Cerebral palsy • Deaf or serious difficulty hearing • Diabetes • Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders • Epilepsy or other seizure disorder • Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome • Intellectual or developmental disability • Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD • Missing limbs or partially missing limbs • Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports • Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS) • Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities • Partial or complete paralysis (any cause) • Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema • Short stature (dwarfism) • Traumatic brain injury

Do you Have a Disability * Required Select Yes, I have a disability, or have had one in the past No, I do not have a disability and have not had one in the past I do not want to answer

PRE-OFFER 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.

Are you a protected Veteran * Required Select I identify as one or more of the classifications of protected Veterans I am not a protected Veteran I choose not to self-identify

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