Employment Application

We consider applicants for all positions without regard to sex, age, race, color, religious preference, sexual preference, national origin, creed or veteran status, the presence of a non-job related medical condition or disability, or any other legally protected status.

First Name:
Middle Initial:
Last Name:
Present Address:
How Long at that Address:
Position applying for:
Date you are available:
Who referred you to us?
Have you ever been employed by Goodwill?
If so, when and where?
I am 18 years old or olderI am younger than 18 years old

Application will be considered active for 30 days
For consideration after that, you must reapply

Education Name/Address Last Grade Completed Diploma/Degree Subjects Studied
Grade School
High School

Graduate School
Trade School

Have you ever been convicted of a felony?

Special skills and qualifications?

Employment Record - List Most Current Job First

Company Name Address/Phone Dates Pay Rate Position Held Reason for Leaving

References Other Than Previous Employers

Name Address/Phone Occupation

The schools, companies, and persons named in this application may give information regarding me and I hereby release them from all liability for doing so. I understand that employment is conditional upon satisfactory replies from references, including former employers. I understand that falsification of any information given on this application shall be cause for rejection of application and prohibit the applicant from any employment whatsoever by Goodwill. I further understand that, if hired, falsification of any information given on this application shall be cause for immediate termination.

I certify that the above information is true and correct to the best of my knowledge.