Application for Employment
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
PERSONAL INFORMATION
Position(s) Applied For
*
Date of Application
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-
Month
-
Day
Year
Date
Full Name
*
First Name
Middle Name
Last Name
Social Security #
Current Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Telephone Number
*
Format: (000) 000-0000.
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Referral Source (How Did you Hear About Us?)
*
Are you legally eligible for employment in this country?
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Yes
No
Date available for work
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-
Month
-
Day
Year
Date
What is your desired salary range?
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Type of Employment Desired?
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Full-Time
Part-Time
Temporary
Educational Co-Op
Answering “Yes” to either of the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Have you ever been employed here?
*
Yes
No
Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation? This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
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Yes
No
Need more information about the job’s “essential functions” to respond Driver’s License number required if driving may be required in the job for which you are applying
If you are under 18 years old, can you furnish a work permit if required?
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Yes
No
N/A
Have you ever pleaded “guilty” or “no contest” to, or been convicted of a crime?
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Yes
No
If yes, please provide date(s) and details:
Skills and Qualifications. Summarize any special training and/or certificates that may assist you in performing the position for which you are applying
Computer Skills (Check appropriate boxes. Include Software titles and years of experience)
Word Processing
Spredsheet
Presentation
Email
Internet
Other
Software Titles and Years of Experience
Employment History
Starting with your most recent employer, provide the following information:
Employer
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Dates Employed
Date Previous Job Started
/
Month
/
Day
Year
Date
Date Previous Job Ended
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Starting Job Title / Final Job Title
Immediate Supervisor and Title (for most recent position held)
May we contact for reference?
Yes
No
Later
Why did you leave?
Summarize the type of work performed and job responsibilities.
Compensation (Starting)
Hourly
Salary
$/per
Commission/Bonus/Other Compensation- $
Compensation (Final)
Hourly
Salary
$/per
Commission/Bonus/Other Compensation- $
Educational Background
Starting with your most recent school attended, provide the following information:
School
Years Completed
Completed
Diploma
Degree
Certificate
GED
Other
GPA/Class Rank
Major/Minor
School
Years Completed
Completed
Diploma
Degree
Certificate
GED
Other
GPA/Class Rank
Major/Minor
School
Years Completed
Completed
Diploma
Degree
Certificate
GED
Other
GPA/Class Rank
Major/Minor
Goodwill Industries of Kanawha Valley,
Inc Confidential Proprietary Applicant Document
REFERENCES:
Name
Title
Relationship to you
Telephone
# of Years Known
Name
Title
Relationship to you
Telephone
# of Years
Name
Title
Relationship to you
Telephone
# of Years
Applicant Statement
I expressly authorize, without reservation, Goodwill Industries of Kanawha Valley, Inc., its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy if all information provided by me in this application, résumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by local, state or federal law.I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing expressed language are valid unless they are in writing and signed by the employer’s President/CEO.I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that Federal immigration laws require me to complete an I-9 Form in this regard.Goodwill Industries of Kanawha Valley, Inc. does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of sex, race, color, religion, national origin, citizenship, age, disability or any other protected status under applicable Federal, State, or Local Law. Goodwill Industries of Kanawha Valley, Inc. does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability or any other protected status. Goodwill Industries of Kanawha Valley, Inc. takes all complaints of harassment seriously and call complaints will be investigated promptly and thoroughly.I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further employment consideration, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature
*
Name
*
First Name
Last Name
Date of Application
*
-
Month
-
Day
Year
Date
Goodwill Industries of Kanawha Valley,
Inc Confidential Proprietary Applicant Document
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