Online Employment Application

Step 1: Contact Information
*Position Applying For:
How did you learn about us?
Referred by?
*Last Name
*First Name
Middle Name
*Current Street Address
*City, State, Zip	,
*E-mail Address
*Telephone Number
(Cell) Alternate Telephone Number
Previous Street Address
City, State, Zip	,
Number of Years at Previous Address

Step 2: General Information
Best time and phone number to contact you is:
*Are you a citizen of the US or a permanent resident alien?	Yes No
If No, please note US Visa Status
*Have you ever filed an application with us before?	Yes No
If Yes, date
*Have you ever been employed by us before?	Yes No
If Yes, when and where
*Are you a veteran?	Yes No
If Yes, please indicate branch of service
*Do any of your friends, relatives, and/or spouse work here?	Yes No
*Are you currently employed?	Yes No
*May we contact your present employer?	Yes No
*Date available for work
*What is your desired salary range
*Are you available to work (select all that apply)	Full Time Part Time Temporary

Step 3: Education
High School:
High School Name
City
State
Graduated High School	Yes No

Undergraduate College:
Undergraduate College Name
Undergraduate College City
Undergraduate College State
Undergraduate College Course of Study
Undergraduate College Years Completed
Undergraduate College Diploma Degree

Graduate Professional:
Graduate Professional Name
Graduate Professional City
Graduate Professional State
Graduate Professional Course of Study
Graduate Professional Years Completed
Graduate Professional Diploma Degree

Other (Please Specify):
Other School Name
Other School City
Other School State
Other School Course of Study
Other School Years Completed
Other School Diploma Degree or Certificate

Step 4: Experience
Starting with your most recent employer:

Employer Name
Address
City, State, Zip	,
Telephone Number
Job Title
Supervisor
Reason for Leaving
Dates Employed
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Work Performed/Experience/Special Skills

Step 5: Additional Information
List professional, trade, or business memberships. Describe any specialized training or apprenticeship you have completed.
Other qualifications - summarize special job-related skills and qualifications from employment or other experience
Computer Skills - Spreadsheet, Keyboard, Word Processing, PC/MAC, NA, Other

Step 6: References
Reference 1
Full Name
Company
Current Address
City, State, Zip	,
Phone Number
Relationship to you

Reference 2
Full Name
Company
Current Address
City, State, Zip	,
Phone Number
Relationship to you

Step 7: Copy/Paste a Resume

Resume/Skills: (Please paste your resume in the box below. If you do not have a resume, please list current or relevant job responsibilities.)

Step 8: Applicant Statement:

I understand and agree that if I am hired by Columbia Bank ("The Bank") I will be an at-will employee and my employment may be terminated by The Bank or me at any time, with or without cause.

Nothing contained in any manual, handbook, policy statement or work rule of Columbia Bank constitutes a promise of any kind or contract or agreement for a definite term of employment. Regardless of anything stated in any manual, handbook, policy statement or work rule, the employment relationship between Columbia Bank and each of its employees is terminable at the will of either party at any time and Columbia Bank continues to have the absolute power to fire anyone with or without good cause, without prior notice and without complying with any applicable procedures; the company also remains free to change the terms and conditions of employment (including but not limited to, wages and benefits) as to any employee and the terms of any manual, handbook, policy statement or work rule without consulting with anyone or obtaining anyone's agreement.

This disclaimer may not be altered in substance or application except by written agreement signed by the President of Columbia Bank.

I hereby state that the information provided in this application is true to the best of my knowledge. I further state that I have not omitted or failed to disclose any information requested to be provided in this application. I understand that if any of the information provided herein is false or if I have omitted any material information, my application may be rejected or my employment may be terminated.

I authorize my present and former employers and individuals whom I have listed as personal references to furnish Columbia Bank information about my employment including, but not limited to, the reason(s) for the termination of my employment, my work performance, and my skills, abilities and other qualities pertinent to my employment.

I hereby release the persons and entities who furnish information about my employment from any and all liability arising from the furnishing of such information.

I also authorize Columbia Bank to obtain and review information relating to my credit history and to take my fingerprints. I also acknowledge that I have been notified that the Bank reserves the right to conduct drug tests on all applicants for employment.

I have read and understand the foregoing statement and I agree with everything in it.

Step 9 - Affirmative Action/Equal Opportunity - Voluntary Applicant Self-Identification Form

Columbia Bank is an Equal Opportunity/Affirmative Action employer committed to diversity in the workplace. As a federal contractor we are subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Columbia requests applicants to self-identify their race and ethnicity. The information you provide will be kept confidential and completely separate from your application for employment, and will not be used in making employment decisions. Your cooperation in providing this information is strictly voluntary.

I do not wish to complete the identification portion of this application

Gender: Male Female

Please identify to the following government definitions of race and ethnicity by checking one (or more) applicable categories.

HISPANIC/LATINO
All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture regardless of race.

BLACK/AFRICAN AMERICAN
All persons having origins in any of the black racial groups of Africa.

ASIAN
All persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent. Including, for example, China, Japan, Korea, India, Cambodia, Thailand, the Philippine Islands, and Vietnam.

NATIVE HAWAIIAN/PACIFIC ISLANDER
All persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

AMERICAN INDIAN OR ALASKA NATIVE:
All persons having origins in any of the original peoples of North America, and South America (including Central America), and who maintain cultural identification through tribal affiliation or community recognition.

WHITE
All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

TWO OR MORE RACES
All persons who identify with one or more of the above six races.

AFFIRMATIVE ACTION/EQUAL OPPORTUNITY VOLUNTARY APPLICANT SELF-IDENTIFICATION OF DISABILITY

Columbia Bank is an Equal Opportunity/Affirmative Action employer committed to diversity in the workplace. As a Federal Contractor we are subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Columbia requests applicants to self-identify whether or not they have a disability. The information you provide will be kept confidential and completely separate from your application for employment, and will not be used in making employment decisions. Your cooperation in providing this information is strictly voluntary.

*Please choose one	Yes, I have a disability
	No, I do not have a disability
	I do not wish to complete this form

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 Disorder
Cancer	HIV/AIDS	Multiple Sclerosis (MS)	Impairments requiring the use of a wheelchair
Diabetes	Schizophrenia	Epilepsy	Muscular Dystrophy
Missing limbs	Partially missing limbs	Intellectual disability (previously called mental retardation)

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.

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

By clicking "Submit" you will be sending your online application and resume to Columbia Bank. If you need to review your application, please use the previous buttons below.

Step 10 - INVITATION TO PROTECTED VETERANS Columbia Bank is a government contractor subject to 38 U.S.C. 4212 (d) which requires federal contractors and subcontractors to take affirmative action to employ and advance in employment protected veterans. If you are a protected veteran, and would like to be considered under the affirmative action program, please tell us. This information is voluntary and will be kept confidential and completely separate from your application for employment, and will not be used in any employment decisions. Although information obtained concerning individuals shall be kept confidential, expect that (i) supervisors and managers may be informed regarding restrictions on work or duties and regarding accommodations (ii) first aid personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment; and (iii) government officials investigating compliance with the ADA shall be provided relevant information on request. In order to assure proper placement of all employees, we do request that you answer the following questionnaire.

VOLUNTARY SELF-IDENTIFICATION OF PROTECTED VETERAN STATUS Columbia Bank has an Affirmative Action Program for the employment, advancement in employment and administration of fair employment practices for Protected Veterans. A definition of "protected veteran" has been added to provide a comprehensive term to refer to any veteran that is protected under the VEVRAA regulations. Disabled veterans, Recently Separated Veterans, Active Duty Wartime or Campaign Badge veterans, and Armed Forces Service Medal Veterans are protected veterans under VEVRAA. (Vietnam Era Veterans' Readjustment Assistance Act of 1974) Definitions of these terms are below: Disabled Veteran means: (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 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. Active Duty Wartime or Campaign Badge Veteran are veterans 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 Armed Forces Service Medal Veteran means 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 (61 FR 1209).

*If you wish to be considered under any of these plans, please check the appropriate box(es).
DISABLED VETERAN
RECENTLY SEPERATED VETERAN (WITHIN LAST 3 YRS)
ACTIVE DUTY WARTIME OR CAMPAIGN BADGE VETERAN
ARMED FORCES SERVICE MEDAL VETERAN
I DO NOT WISH TO COMPLETE THIS FORM
I understand that submission of this information is voluntary and shall be kept confidential except that supervisors, first aid and safety personnel and government officials may be informed as appropriate.