General Information
Social Security
No
First Name
Last Name
Middle Initial
Home Phone
How Long at Present Address?
Present Street Address
Address (cont.)
City
State
Zip/Postal Code
E-mail
Resume URL
Position Applying For
Date Available
Who Referred you to us?
Have you ever been employed by
Goodwill?
If yes to above - When & Where?
Have you ever been convicted of a
felony?
Yes No
If Yes to
above - please explain
Education Information
High School
High School Name and Address:
Last grade completed:
8
9
10
11
12
Receive Diploma?
Yes
No
Subjects Studied:
College
College Name and Address:
Years of College completed:
1
2
3
4
5
6
7
8
Receive Diploma?
Yes
No
Subjects Studied:
Graduate School
Graduate School Name and Address:
Years of Grad School completed:
1
2
3
4
5
6
7
8
9
10
11
12
13
Receive Diploma/Certificate?
Yes
No
Subjects Studied or Advanced
Degrees:
Trade/ Business School
Trade School Name and Address:
Last grade completed:
8
9
10
11
12
13
14
15
16
Receive Diploma?
Yes
No
Trade or Business Studied:
List your Special Skills or
Qualifications:
Equipment you operate:
In case of emergency, notify name
Phone
Employment History Record:
In the space to the right, please list jobs held with
the most current job first. Give the Company Name, Address, Date
employed, pay rate, your position, supervisor name and reason for
leaving.
Of all your jobs, which was most
interesting?
References other than previous
employers:
Please provide the Name, Address, and Occupation of three (3)
different references other than your previous employers.
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 form shall be cause for rejection
of application and prohibit the applicant from any employment whatsoever
by Goodwill. Any employee who falsifies application information or who
gives false information at the time of the physical examination is
subject to immediate termination. If hired, it is recognized that an
employee can terminate his/her employment at any time. Goodwill reserves
the same right.
Digitally sign
this application: Please enter your social
security number in the following box and check the "SIGN"
checkbox and then click the "SUBMIT FORM" button below to send
your application to Goodwill Industries of Wayne and Holmes Counties, Inc.
Digital Signature: Social
Security Number
Check this box to sign
Note: Application will not be complete unless
you digitally sign this form as outlined above.