Employee Application

Goodwill Industries of Wayne and Holmes Counties, Inc.

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. Date
Date*

MonthDayYear
Last*
First*
Middle Initial
Phone*
Present Address (Street)*
How Long?*
City/State and Zip*
Position applying for
Date available*

MonthDayYear
Who referred you to us?*
Have you ever been employed by Goodwill?*
If so, when and where?
Are you 18 years or older?*
High School Name and Address*
Last High School Grade Completed*
High School Diploma Recieved (Yes/No)*
College Name and Address
College Last Grade Completed
College Diploma/Degree Recieved
College Subject Studied
Graduate School Name and Address
Graduate School Last Grade Completed
Graduate School Diploma/Degree Received
Graduate School Subjects Studied
Trade School Name and Address
Trade School Last Grade Completed
Trade School Diploma/Degree
Trade School Subjects Studied
Have you ever been convicted of a felony?
Special skills and qualifications?*
Equipment you operate?
EMPLOYMENT RECORD - LIST MOST CURRENT JOB FIRST
Company Name
Company Address and Phone
Dates Employed
Pay Rate
Position Held
Reason for Leaving
Company Name
Company Address and Phone
Dates Employed
Pay Rate
Position Held
Reason for Leaving
Company Name
Company Address and Phone
Dates Employed
Pay Rate
Position Held
Reason for Leaving
Company Name
Company Address and Phone
Dates Employed
Pay Rate
Position Held
Reason for Leaving
Company Name
Company Address and Phone
Dates Employed
Pay Rate
Position Held
Reason for Leaving
REFERENCES OTHER THAN PREVIOUS EMPLOYERS
Name
Address/Phone
Occupation
Name
Address/Phone
Occupation
Name
Name
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.
Why did you choose to apply at Goodwill and why do you want to work here?
Signature*

Clear
Should be Empty:

EMPLOYMENT RECORD - LIST MOST CURRENT JOB FIRST

REFERENCES OTHER THAN PREVIOUS EMPLOYERS