PRE-HIRE APPLICATION PACKET

CANDIDATE INFORMATION PAGE

Position you are seeking?
Legal Name (First & Last)
Preferred Name
Home Address
Address 2
City
State
Zipcode
NMLS#(if applicable)
How did you hear about us?
Name of Employee	This field is required.
Name of Recruiter	This field is required.
Other, Please explain:
This field is required.
Please Specify:

Social Security
Date of Birth
Home Phone
Mobile Number
Personal Email
Other Languages which you can read and write fluently

REALTOR EXPERIENCE

Do you have recent Mortgage Industry experience (within the past year)?:
Total years of real estate industry experience:


Yes No

Total years of mortgage industry experience (if applicable):


Current Active Positions of Employment (list all):


Current Active Employers (list all including self-employment):


Are you an active licensed realtor in good standing?:
Yes No
If yes, please provide the states and license numbers. Please note Utah is not eligible.


Are you a Broker Owner?:
Yes No

Are you a Broker Owner in any of these states: New Jersey, Tennessee, Alabama, or Nebraska?:
Yes No

Are you a Managing Agent, Referring Agent, or Supervising Agent?:
Yes No

How many buyer-side transactions?:
YTD: Prior Year:

How many seller-side transactions?:
YTD: Prior Year:

TECHNOLOGY

The Federal Savings Bank offers a "Bring Your Own Device" program for mobile devices. Please answer these questions to check your device's compatibility.

Mobile Device Information

To ensure compatibility with our IT systems, please provide the following information about your mobile device. If your device is found to be incompatible with our systems, you may need to obtain a new device at your own expense.

What type of mobile device(s) do you use? (Check all that apply)?

Apple iPhone or iPad

Android or Tablet

Note: Only Apple and Android mobile devices are supported. You may enable more than one device.

What is the model name and version of your primary device?

Model:

Example: iPhone 16

Version:

Example: 18.3.1

How to find your model and version?

For iPhone/iPad: Go to Settings > General > About, and look for the "Model Name" and "Software Version."
For Android: Go to Settings > About Phone, and look for the "Model Name" and "Android Version."

Note: The company supports the current and previous software versions for Apple devices, as well as the current and last two versions for Android devices. Version support is updated annually every January. Devices that cannot be upgraded or were purchased more than seven years ago are generally not supported.

EMPLOYMENT BACKGROUND CHECK AUTHORIZATION

Application Consent Form for Pre-Employment Investigation

In consideration of The Federal Savings Bank's review of my application for employment, I hereby authorize The Federal Savings Bank and its designated agents and representatives to conduct a comprehensive review of my background and to cause a consumer report and/or an investigative consumer report to be generated for employment purposes. I understand that the scope of the consumer report and/or investigative consumer report may include, but is not limited to, the following areas: verification of social security number; credit reports; current and previous residences; employment history; education background; character references; drug testing; civil and criminal history records from any criminal justice agency in any or all federal, state, and/or county jurisdictions; driving records; military service verification; and any other records of any kind or nature whatsoever.

I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to The Federal Savings Bank or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, including but not limited to information or data received from other sources.

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In addition, please answer the following questions:

Please disclose all instances, regardless of timeframe, severity or whether they were expunged, including but not limited to DUI, speeding, public intoxication, drug-related offences, etc. The Federal Savings Bank will use an FBI Criminal Background Check report available on NMLS upon your NMLS registration or transfer.


1. Have you ever been arrested, charged with, or convicted of any felonies?	Yes No
If yes, please describe circumstances:
2. Have you ever been arrested, charged with, or convicted of any misdemeanors?	Yes No
If yes, please describe circumstances:

3. Have you ever been arrested, charged with, or convicted of a felony or involved in a civil lawsuit involving a breach of trust, money laundering, or dishonesty?	Yes No
If yes, please describe circumstances:

4. Have you ever had a mortgage loan originator license revoked or suspended by any regulator?	Yes No
If yes, please describe circumstances:

5. Have you ever voluntarily resigned, been discharged, or permitted to resign after allegations were made that accused you of fraud, dishonesty, theft, or the wrongful taking of property?	Yes No
If yes, please describe circumstances:

6. Have you ever become insolvent, filed bankruptcy, failed in a business venture, or compromised your debts with creditors?	Yes No
If yes, please explain:

7. Do you have the ability to verify your identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire?	Yes No
8. Apart from your current employer, are you employed/contracted by any additional companies, individuals or self-employed business?	Yes No
If yes, please list name of company or self-employed business and position(s) held:

One or more questions were answered 'yes'. Please provide a Letter of Explanation (LOX) below. The letter should include a factual, high-level summary of the event(s), circumstances, and resolution. Context, responsibility, and measures taken to prevent the recurrence should also be addressed.

The information above is true and complete. I understand that providing false information will result in my immediate termination of employment.
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CONSENT TO ELECTRONIC DISCLOSURE

I affirmatively consent to The Federal Savings Bank ("TFSB") electronically corresponding with me, including the sending of any disclosures required by the U.S. Fair Credit Reporting Act (the "FCRA disclosures"). I understand that I may retain a paper copy of the correspondence by printing out a copy (if a printer is available) when I review it electronically or by requesting a paper copy from The Federal Savings Bank, 4120 W. Diversey Ave, Ste C501, Chicago, IL 60639 at no charge. I hereby release and hold harmless The Federal Savings Bank and its agents, officials, representatives or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family or associates because of compliance with this consent or as a result of disclosure, including any inadvertent disclosure to an incorrect email address. I understand that I have the right to withdraw this Consent to Electronic Disclosure by contacting The Federal Savings Bank, 4120 W. Diversey Ave, Ste C501, Chicago, IL 60639. I understand that if there is any change in the e-mail address I provide herein, I may provide an updated e-mail address to The Federal Savings Bank, 4120 W. Diversey Ave, Ste C501, Chicago, IL 60639. I understand that to access the correspondence, I must be able to view it on a computer monitor, which I may do by using any computer with an Internet browser.

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AUTHORIZATION TO PULL CREDIT FOR EMPLOYMENT PURPOSES

Date
Applicant's Name
Any former or alias names
SSN#		Date of Birth

I hereby authorize The Federal Savings Bank (TFSB) to obtain a credit bureau investigation report for employment investigation purposes. I understand that the information contained within the credit report will be reviewed by TFSB personnel and that such information is a partial basis of employment. I further understand that if employed with TFSB, a credit report may be periodically pulled for promotions, position changes, or continued employment.

I acknowledge that TFSB is relying on third party information and I therefore hold harmless TFSB, its owners, Officer, Directors, agents or employees from any and all liability arising from requesting, procuring, or furnishing the requested information, including any erroneous or omitted information contained in my credit bureau report.

If an adverse employment decision is made due, in whole or in part, to information obtained from the credit bureau, TFSB will give me a copy of the credit report, a summary of my rights under the Fair Credit Reporting Act, and the contact information of the agency used to pull the report.

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AT-WILL EMPLOYMENT

You acknowledge and agree that The Federal Savings Bank is an "at will" employer. This means that the Company may terminate your employment at any time and for any reason, with or without cause, and that you too may choose to resign for any reason. Your at-will employment may not be eliminated or modified except in a written document signed by the Company's President and/or CEO.

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Voluntary Information

This information is being requested in accordance with federal regulations. The information is voluntary and will not be used when considering you for employment with our company.

Military Service

	ARMY
	MARINE CORPS
	NAVY
	AIR FORCE
	COAST GUARD
Were you discharged?		Yes No
If yes, what type of discharge did you receive?
Title
Years Served

Professional References

Please list two professional references who are familiar with your work history, position, job functions and responsibilities.

Reference 1

Reference 2

Name
Relationship
Company
Years Known
Address
Phone Number
Email

Name
Relationship
Company
Years Known
Address
Phone Number
Email

EEOC requirement

The Federal Savings Bank is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Voluntary Demographic Self Identification Form

The Equal Employment Opportunity Commission (EEOC) requires all private employers with 100 or more employees as well as federal contractors and first-tier subcontractors with 50 or more employees AND contracts of at least $50,000 complete an EEO-1 report each year. Covered employers must invite employees to self-identify gender and race for this report.

Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for EEO-1 and Affirmative Action Plan reporting purposes only and will be kept separate from all other personnel records only accessed by the Payroll & Benefits Department.

If you choose not to self-identify your race/ethnicity at this time, the federal government requires The Federal Savings Bank to determine this information by visual survey and/or other available information.

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Date Completed:

GENDER:

(Please check one of the options below)

Male

Female

I do not wish to disclose

RACE/ETHNICITY:
(Please check one of the descriptions below corresponding to the ethnic group with which you identify.)
	Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
	White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
	Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.
	Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
	Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
	Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
	Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.
	I do not wish to disclose.

DISABILITY:

(Please check one of the options below)

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 wish to disclose