EEOC Application

Goodwill Industries is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program.



Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as handicapped, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation, you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.



Please complete the information requested below. Thank you for your cooperation.



Section 1: General Applicant Information


Date:
Name:
Position applied for:



Section 2 Referral Source - Please check one

Current Emplopyee PostingWalk InNewspaper AdOther
If other:


Section 3: Applicant Affirmative Action Data

A. Gender:

MaleFemale



B. Race/Ethnicity (Check all that apply)

Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture origin regardless of race)White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa)Black or Africa American (A person having origins in any of the black racial groups of Africa)Native Hawaiian or Other Pacific Islander (A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands)Asian (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)American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment)Two or more races (All persons who identify with more than one of the above five races)Do not wish to identify (All persons not wishing to self-identify race/ethnicity)



C. Veteran Status – Check all boxes that apply

Vietnam era veteran (Veteran of the Vietnam Era: A person who (I) served on active duty in the U.S. military, ground, naval, or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; OR;(II) was discharged or released from active duty in the U.S. military, ground, naval, or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (B) between August 5, 1964 and May 7, 1975, in any other location.)Special Disabled veteran (Special Disabled Veteran: 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 Department of Veterans’ Affairs for a disability – a) rated at 30% or more; b) rated at 10 or 20% in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap; or c) a person who was discharged or released from active duty because of service connected disability.)Other eligible veteran (Other Protected Eligible Veteran: 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, a service medal, or an expeditionary medal has been authorized. To identify campaigns or expeditions that may meet this criteria, you may visit the following website: www.opm.gov/veterans/html/vgmedal12.htm or send an email to othervets@vets100.com to request a copy of the list.)Newly separated veteran (Newly Separated Veterans: Any veteran who served on active duty in the U.S. military, ground, naval or air service during the past one-year period, beginning on the date of such veteran’s discharge or release from active duty.)