EMPLOYMENT APPLICATION

Please answer all of the questions completely and accurately. Note that upon hire you must agree to sign
the Employment Eligibility Verification (Form I-9). As required by the Immigration Reform and Control Act
of 1986 and provide supporting documents.
Prospective employees will receive consideration without discrimination based on race, color, age, sex,
national origin, disability, veteran status or any condition prescribed by federal, state, or local law.
I understand that my application is valid only if applying for a job opening and if I am qualified for that job. I
may apply for only one position at a time. I may reapply for employment in the future by completing a new
application.

Date of Application: Position Applying For:

Requisition Number: Full Time Part Time

PERSONAL INFORMATION

Name:
(Last) (First) (Middle)

Street Address:___________________________ ___________ City:__________________

State: ______________ Zip Code:_________ ___ County: _________________________

Telephone No: Home: Alternate:

Are you legally authorized to work in the United States? YES NO

Will you at any time require sponsorship for employment visa status? YES NO

Are you at least 18 years of age? YES NO

Have you previously applied or been employed with PlainsCapital? YES NO

If yes: month, year, and location:

Are you related to anyone currently employed with PlainsCapital? YES NO

If yes: name/s and location:

Salary requirements:

Have you ever pled guilty or been convicted of a crime or misdemeanor of any type or
participated in deferred adjudication or a similar program or received a prior conviction of
any crime? YES NO

If yes; please provide more specific information. A conviction will not necessarily disqualify
you from employment consideration.

County: State: Disposition of Conviction:

REFERRAL INFORMATION SOURCE (Please list all that apply)

_________________________________________________________________________________
Revised June 2009 PlainsCapital Is An AA/EEO D/V/M Employer
 EMPLOYMENT APPLICATION

EDUCATION

High School Graduated or GED

Name: YES NO

City:

State:

College Graduate Major Courses

Name: YES NO _____________________

City: _____________________

State: Degree: _____________________

Graduate School Graduate Major Courses

Name: YES NO _____________________

City: _____________________

State: Degree: _____________________

Other Education Graduate Major Courses

Name: YES NO _____________________

City: _____________________

State: Degree: _____________________

List scholastic honors, honorary organizations, scholarships:

Special Business Skills:

Special Computer Skills:

Professional Credentials (licenses):

Professional Organizations:

Revised June 2009 PlainsCapital Is An AA/EEO D/V/M Employer

 EMPLOYMENT APPLICATION

EMPLOYMENT HISTORY

List current or last employer first, then follow with previous employers. Provide accurate
full-time and part-time employment information explaining any gap (s) in employment
history. Please be thorough.
May we contact your current employer? YES NO

Current / Last Employer

Name: Dates Employed: Work Performed:

Complete Address: From: ________________________

To: ________________________

Corporate Phone: ________________________

Job Title: ________________________

Supervisor: Rate of Pay: Reason for Leaving:

Title: Start: ________________________

Phone: End: ________________________

Previous Employer

Name: Dates Employed: Work Performed:

Complete Address: From: ________________________

To: ________________________

Corporate Phone: ________________________

Job Title: ________________________

Supervisor: Rate of Pay: Reason for Leaving:

Title: Start: ________________________

Phone: End: ________________________

Revised June 2009 PlainsCapital Is An AA/EEO D/V/M Employer

 EMPLOYMENT APPLICATION
Previous Employer

Name: Dates Employed: Work Performed:

Complete Address: From: ________________________

To: ________________________

Corporate Phone: ________________________

Job Title: ________________________

Supervisor: Rate of Pay: Reason for Leaving:

Title: Start: ________________________

Phone: End: ________________________

Previous Employer

Name: Dates Employed: Work Performed:

Complete Address: From: ________________________

To: ________________________

Corporate Phone: ________________________

Job Title: ________________________

Supervisor: Rate of Pay: Reason for Leaving:

Title: Start: ________________________

Phone: End: ________________________

Previous Employer

Name: Dates Employed: Work Performed:

Complete Address: From: ________________________

To: ________________________

Corporate Phone: ________________________

Job Title: ________________________

Supervisor: Rate of Pay: Reason for Leaving:

Title: Start: ________________________

Phone: End: ________________________

Revised June 2009 PlainsCapital Is An AA/EEO D/V/M Employer

 EMPLOYMENT APPLICATION
NOTICE TO JOB APPLICANTS

PlainsCapital Corporation has the right to verify certain information contained in your
application for employment. The information requested below is necessary to complete this
task. This information is NOT a part of the application for employment and will be used for
the sole purpose of verification of information, and or statements made by you.

Please complete all information requested.

It is possible that your employment may be determined in whole or in part by PlainsCapital Corporation using
data from a report supplied by a background service company. Pursuant to Section 609 of the Fair Credit
Reporting Act, you may be entitled to a copy of this report.
Applicant’s Last First M.I.
Legal Name
Please provide any Last First M.I
other name used for
prior employment or
school that
differentiates from
the above.

Date of Birth: Social Security #

(Month/Day/Year)
Name as it Appears on Driver’s License:

Driver’s License # State:

Residential History: List all residential addresses in the last 7 years

Address City State Zip From Present

Address City State Zip From To

Address City State Zip From To

APPLICANT CONSENT
I understand and agree that PlainsCapital Corporation will verify all or part of the information I have
provided. I understand that this verification may include any inquiry into my credit history, motor
vehicle driving record, criminal and civil records, prior employment (including contacting prior
employers), education (degree, GPA and attendance) as well as other public record information. I
authorize the release of such information as may be necessary to verify the information I have
provided. I release and hold harmless from all liability any individual or entity requesting or supplying
information with respect to my application for employment. I certify that all statements made by me
on this application are true and complete to the best of my knowledge, and that I withheld nothing
that would, if disclosed, affect this application unfavorably.

I hereby do or do not authorize you to contact my current employer for Employment

and Reference Verifications.

Applicant Signature: Date:

Revised June 2009 PlainsCapital Is An AA/EEO D/V/M Employer

 EMPLOYMENT APPLICATION

PERSONAL REFERENCES

Give name, address, telephone number and relationship of three references that are not
related to you and are not previous employers.

1.

2.

3.

I understand that certain jobs may require a criminal background investigation, and I
authorize the company to perform that investigation at Company expense. I understand
that the Company may refuse to hire me as a result of that investigation, and I agree to
hold the company harmless. I agree that refusal to authorize the background
investigation will constitute my voluntary withdrawal from the selection process. I
authorize the Company to undertake an investigation of all information contained in this
application for employment or resume as presented for consideration for employment. I
release from all liability all persons, companies, and corporations supplying such
information. The information I have provided in this application for employment is true,
correct, and complete. False, incomplete or misrepresented information of any kind will
be sufficient cause for my application to be rejected or, if discovered after I am employed,
cause for termination of my employment.

I also understand that the Company may periodically conduct a background

investigation/credit check during the course of my employment.

Additionally, I understand that nothing contained in this employment application or in the

granting of an interview is intended to create an employment contract between the
Company and me for either employment or for the providing of any benefit. No promises
regarding employment relationship is established, I understand that I have the right to
terminate my employment at any time and that the Company retains the same right.

I have read and understood the above.

Signature of Applicant: Date: ________

Revised June 2009 PlainsCapital Is An AA/EEO D/V/M Employer

 EMPLOYMENT APPLICATION

EMPLOYMENT DATA RECORD

Employees are treated during employment without regard to race, color, religion, sex,
national origin, age, marital or veteran status, medical condition or disability, or other
legally protected status. As an employer with an Affirmative Action Program, we comply
with government regulations, including Affirmative Action responsibilities where they apply.
The purpose for this data record is to comply with government record keeping, reporting,
and other legal requirements. Periodic reports are made to the government on the
following information. The completion of this data record is optional. If you choose to
volunteer the requested information please note that all data records are kept in a
confidential file and are not a part of your Application for Employment or personnel file.
Please note: your cooperation is voluntary. Inclusion or exclusion of any data will not affect
any employment decision.

VOLUNTARY SURVEY

Government agencies at times require periodic reports on the sex, ethnicity, disability,
veteran and other protected status of employees. This data is for statistical analysis with
respect to the success of the Affirmative Action program. SUBMISSION OF THIS
INFORMATION IS VOLUNTARY.

Please Print

Name:
(Last) (First) (Middle)

Current Job: Date:

Check One: Male Female

Check one of the following: (Ethnic Origin)

White Hispanic American Indian/Alaskan Native

Black Other Asian/Pacific Islander

Check which type of position you are applying for:

Clerical Professional Official/Manager Service or Operator

Which of the following is applicable?

Served in the U.S. Armed Forces

Vietnam Veteran Disabled Veteran Disabled Individual

Revised June 2009 PlainsCapital Is An AA/EEO D/V/M Employer