Employment Application

We are an equal opportunity employer, prohibiting discrimination of employment on the basis race, religion, sex, age, national origin, disability or status as a Vietnam Era or special disabled veteran.

Referral Source:


Type of employment desired:

Employment History




Computer Skills

Educational Background



To agree to the below “Applicant Statement” and to accept electronic services and communications according to the “Consent and Notice Regarding Electronic Communications”, indicate your consent to the terms and conditions of these Agreements by clicking on the "I Accept and Submit" button.

It is recommended that you print a copy of this Agreement for future reference.

Applicant Statement:

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct.

I understand that any information provided by me is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to eliminate me from further consideration for employment, or may result in my immediate discharge from the employer’s service, whenever it is discovered.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and the federal immigration laws require me to complete an I-9 Form in this regard.

I agree upon consideration of employment to sign a background investigation consent form.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all the information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the forgoing express new language are valid unless they are in writing and signed by the employers president.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Consent and Notice Regarding Electronic Communications

Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide Bank and website address, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and the Bank. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature in obtaining a Bank OnLine service constitutes your agreement to be bound by the terms and conditions of the Bank OnLine Disclosures and Agreements as they exist on the date of your E-Signature.

Consent to Electronic Delivery. You specifically agree to receive and/or obtain any and all Bank OnLine related "Electronic Communications" (defined below) via website address. The term "Electronic Communications" includes, but is not limited to, any and all current and future notices and/or disclosures that various federal and/or state laws or regulations require that we provide to you, as well as such other documents, statements, data, records and any other communications regarding your relationship with the Bank. You acknowledge that, for your records, you are able to use the bank online services to retain Electronic Communications by printing and/or downloading and saving this Agreement and any other agreements and Electronic Communications, documents, or records that you agree to using your E-Signature. You accept Electronic Communications provided via the Bank as reasonable and proper notice, for the purpose of any and all laws, rules, and regulations, and agree that such electronic form fully satisfies any requirement that such communications be provided to you in writing or in a form that you may keep.

Paper version of Electronic Communications. You may request a paper version of an Electronic Communication. You acknowledge that the Bank reserves the right to charge you a reasonable fee for the production and mailing of paper versions of Electronic Communications. To request a paper copy of an Electronic Communication contact us at 505-599-0124.
Revocation of electronic delivery. You have the right to withdraw your consent to receive/obtain communications via the Bank OnLine at any time. You acknowledge that the Bank reserves the right to restrict or terminate your access to Bank OnLine if you withdraw your consent to receive Electronic Communications. If you wish to withdraw your consent, contact us at 505-599-0124.
Valid and current email address, notification and updates. Your current valid email address is required in order for you to obtain bank OnlLine services. You agree to keep the Bank informed of any changes in your email address. You may modify your email address by submitting a written request to the bank, visit a branch location or submit a secure message thru online banking. The Bank may notify you through email when an Electronic Communication or updated agreement pertaining to OnLine is available. The Bank may also use OnLine for Electronic Communications. It is your responsibility to use OnLine regularly to check for Electronic Communications and to check for updates to this Agreement.

Hardware, software and operating system. You are responsible for installation, maintenance, and operation of your computer, browser and software. The bank is not responsible for errors or failures from any malfunction of your computer, browser or software. The bank is also not responsible for computer viruses or related problems associated with use of an online system. The following are the minimum hardware, software and operating system requirements necessary to use OnLine and receive Electronic Communications:

Processor - IBM compatible Pentium PC running Windows 2000
Memory - 4MB RAM
Disc Space - 50 MB's Free Space
Monitor - 800 x 600 resolution
Browser - Microsoft Internet Explorer 6.0 or higher
Internet access - 28.8 modem or better

Controlling Agreement. This Agreement supplements and modifies other agreements that you may have with the Bank. To the extent that this Agreement and another agreement contain conflicting provisions, the provisions in this agreement will control (with the exception of provisions in another agreement for an electronic service which provisions specify the necessary hardware, software and operating system, in which such other provision controls). All other obligations of the parties remain subject to the terms and conditions of any other agreement.

Background Check Consent

By submitting this form I hereby authorize Citizens Bank, and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during the tenure of my employment with Citizens Bank.

I release Citizens Bank and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used.

The following is my true and complete legal name and all information contained herein is true and correct to the best of my knowledge: