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PO BOX 716 Pago Pago, AS 96799 The

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PO BOX 716
Pago Pago, AS 96799
Telephone (684)
633-8143
“The People’s Bank”
“Faletupe o le Atunu’u”
TBAS Emplo
yment Application
1
Territorial Bank of A
merican Samoa is an equal Opportunity employer. This application will not be used
for limiting or excluding any applicant from consideration for employment on a basis prohibited by local,
state, or federal law. Should an applicant need reasonable accommodation in the application process,
please contact us at hr@mytbas.com
.
Please complete all the sections below:
General Information
Applicant Name:
(Last, First, MI)
Date of Application: (Month/Day/Year)
Address:
___________________________________________________________________________________
P.O. Box Village City State Zip Code
Telephone Number:
Email Address:
Employment Position
Position or type of Employment Desired:
Are you over the age of 18?
Are you currently employed? [ ] Yes [ ] No
If not, last day of employment?
How did you hear about us?
[ ] Internet [ ] Newspaper [ ] Other ________________________
[ ] Referred by an Employee of TBAS? if yes complete section below
Name_________________
__________________ Relationship_________________________________
[ ] No
Are you legally entitled to work in the territory?
[ ] Yes, please provide proof of documentation
Have you ever been terminated or asked to resign? [ ] No [ ] Yes If yes, please
state employer, date and complete circumstances:
Yes
No
PO BOX 716
Pago Pago, AS 96799 “The People’s Bank”
Telephone (684) 633-8143 “Faletupe o e Atunu’u
TBAS Emp
loyment Application
2
Are you able to perform the essential functions of the job you are applying for, with or without
reasonable accommodation?
[ ] Yes [ ] No, if not please explain.
[ ] Part-Time [ ] Full-Time [ ] Temporary
Salary Desired:
Date Available:
Education and Training:
High School Graduate Or General Education (GED) Test passed [ ] Yes [ ] No
If no, list the highest grade completed.
College, Business School and Training
Name and
Location
Dates attended
Month/Year
Credits Earned
Graduate
& Year
Major or
Subject
Quarterly
or
Semester
Hours
Other
(Specify)
From
[ ] Yes
[ ] No
To
From
[ ] Yes
[ ] No
To
From
[ ] Yes
[ ] No
To
From
[ ] Yes
[ ] No
To
Occupational
License,
Certificate or
Registration
Number
Where Issued
Expiration Date
Occupational
License,
Certificate or
Registration
Number
Where Issued
Expiration Date
PO BOX 716
Pago Pago, AS 96799 “The People’s Bank”
Telephone (684) 633-8143 “Faletupe o e Atunu’u
TBAS
Employment Application
3
Special Skills (List all pertinent skills and equipment that you can operate)
Employment History: List present and past employment, begin with most recent. Please attach
Resume.
Company Name:
Dates: From:
To:
Address, City, State, Zip
Positions(s) Held:
Pay Rate:
Phone No:
Reason for Leaving:
Name of Supervisor
Duties and Responsibilities:
Company Name:
Dates: From:
To:
Address, City, State, Zip
Positions(s) Held:
Pay Rate:
Phone No:
Reason for Leaving:
Name of Supervisor
Duties and Responsibilities:
PO BOX 716
Pago Pago, AS 96799 “The People’s Bank”
Telephone (684) 633-8143 “Faletupe o e Atunu’u
TBA
S Employment Application
4
Professional References:
Name:
Years
Known
Relationship and Title:
Company:
Home Phone:
Work Address, City, State
Work Phone:
Name:
Years
Known
Relationship and Title:
Company:
Home Phone:
Work Address, City, State
Work Phone:
By my signature below, I authorize Territorial Bank of American Samoa to investigate all references to
secure additional information about me if job related.
I certify that I have read and understood all this employment application. It is agreed and understood
that the employer or agents may investigate my background to ascertain any and all information of
concern to my employment history, whether the same is of record or not, and I release employers and
other persons named herein form all liability for any damages on account of furnishing such information.
I understand that, as an applicant for a position with his bank, I may be asked to demonstrate that I can
perform tasks which are pertinent to the job. I also understand that is offered a job, it may be
conditioned on the results of a physical examination, drug test, and background investigation.
I further certify that I am a genuine applicant for employment and this application is being submitted
solely for the purpose of seeking employment with the employer and for no other reason.
I agree to furnish such additional information and complete such examinations as may be required to
complete my employment files.
I also understand that mis-presentations or omission of information or facts result in my rejection or
dismissal if hired. I agree to abide by all the rules and policies of the employer.
This certifies that this application was completed by me, and that all the entries on it and information in I
t are true and complete to the best of my knowledge
Ap
plicant Signature: _________________________________ Date: _____________________________
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Completed 24 September 2020

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