Application Form



Contact Information

First Name*:
Middle Name:
Last Name*:
Address*:
City*:
State*:
Zip Code*:
Phone/Cell*:
I would like notified via text message of new job postings:
Email*:
SSN*:
Date Of Birth*:
Emergency Contact Person:
Emergency Contact Number:

Availability

Times Available:

Days Available:

Minimum hourly pay rate desired:
Are you available to work rotating shifts?:
Do you have a friend or relative working for Goodwill or Goodwill Temps?:
Please specify names of relative/friends working for Goodwill or Goodwill Temps.:
Have you ever been employed by Goodwill Industries or Goodwill Temps?:
Please specify where you were employed?:
Are you available to work overtime?:

General Information

Have you been convicted of a Felony? A conviction will not necessarily disqualify from employment.*:
If YES, list convictions that are a matter of public record (arrests are not convictions).:
If YES, what County and State were you convicted?:
Are you at least 18 years of age?:
Do you have valid Drivers License or State ID?:
If YES, driver’s license number and state issued:
Have you ever served in the Military?:
If YES, list branch. If NO, put N/A:
Do you have reliable transportation?:
List any previous legal names if different than stated above:

Work History

Company Name:
Supervisor Name:
Address:
City:
State:
Start Date:
End Date:
Phone Number:
Job Title:
Starting Hourly Wage:
Ending Hourly Wage:
Work Duties:
Reason for Leaving:
May we contact?:

Work History

Company Name:
Supervisor Name:
Address:
City:
State:
Start Date:
End Date:
Phone Number:
Job Title:
Starting Hourly Wage:
Ending Hourly Wage:
Work Duties:
Reason for Leaving:
May we contact?:

Work History

Company Name:
Supervisor Name:
Address:
City:
State:
Start Date:
End Date:
Phone Number:
Job Title:
Starting Hourly Wage:
Ending Hourly Wage:
Work Duties:
Reason for Leaving:
May we contact?:

Reference

Company Name:
Name:
Phone:
Email:

Reference

Company Name:
Name:
Phone:
Email:

Reference

Company Name:
Name:
Phone:
Email:

Education

Degree:
City:
State:

EEO

Ethnicity/Race*:
Gender*:
Disability*:
Veteran Status*:

Skills
















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Applicant Statement:

I certify that the answers given herein or my online application are true and complete to the best of my knowledge. I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge the employee at any time with or without cause. It is further understood that this “at will” temporary employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by and authorized by the president of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the employer and the employer customer.

Employer Statement:

 Goodwill Temps is committed to hiring and supporting the employment of individuals with criminal backgrounds. However, some positions with Goodwill Temps cannot be held by individuals with particular criminal convictions.  Goodwill Temps is an equal opportunity employer, dedicated to non -discrimination in employment on the basis of race, color, age, religion, sex, national origin, handicap, disability or marital status.  EOE/AA/M/F/D/V