GOODWILL INDUSTRIES
OF SACRAMENTO VALLEY & NORTHERN NEVADA, INC.
EMPLOYMENT APPLICATION
Goodwill Industries is an equal opportunity employer. Goodwill will not discriminate or tolerate
discrimination against any employee or applicant in any manner prohibited by law. Applicants are
considered for all positions without regard to disability, race, color, religion, sex, national origin, age,
marital or veteran status, the presence of a non-related medical condition or disability or any other
legally protected status.
This application must be filled out completely to be considered for employment. If you need help with
the application, please notify Human Resources at 916-395-9000. We gladly accept resumes,
however, you must fill out this application to be considered. You must submit a separate application for
each position for which you apply. Please type your name at the bottom of the application before
submitting.
Date of application: _____________________
PERSONAL & GENERAL INFORMATION
Name: ___________________________________________________________________________________________
Last
First
Middle
Please indicate other names used in previous employment or schooling: ____________________________
Address: _________________________________________________________________________________________
Street
City
State
Zip
Home Telephone: (
)____________________
Other Contact Number: (
Work Telephone: (
)____________________
Persons Name: ____________________________
Position Desired: ___________________
Choose Position
) __________________
Location Desired: __________________
Choose County
Date Available for Employment: ____________________
Full-Time
Choose Date
Part-Time Salary/Rate Desired: ___________
Where did you hear about this position?
Source: Internet Website
Source Name:
____
AVAILABILITY FOR WORK
Work schedules will include day, evening and weekend hours based on the availability that you
indicate on this application. We expect all of our employees to work multiple evening shifts each week,
weekends and on certain holidays, as needed and determined by the store manager. Notify your
manager immediately if your availability for work hours/days changes. Please indicate below the
shifts you are able to work.
Morning
Monday
Afternoon
Evening
Morning
Friday
Tuesday
Saturday
Wednesday
Sunday
Thursday
Afternoon
Evening
EDUCATION
High School or equivalent: (Please check highest year completed)
Do you have a High School Diploma or GED?
College/University/Other
City/State
Yes
Diploma
# Yrs
10
11
12
No
Degree
Can you, after employment, submit verification of your legal right to work
in the United States?
NOTICE: New employees are required to produce verification of their legal
right to work in the United States and present sufficient and genuine
documents relating to their identity.
Major Area of Study
Yes
No
If under 18, can you provide a work permit?
Yes
No
For positions requiring driving, do you have a current California Drivers License?
Yes
No
Have you ever been convicted of a felony or misdemeanor or agreed to a court
settlement for a lesser crime after being charged with a felony?
NOTE: You will not be denied employment because of a conviction record
unless the offense conflicts with our goals, mission or is related to the job
for which you have applied.
If Yes, please explain. Provide date(s):
_______________________________________________________
Yes
No
Are you currently employed?
Yes
No
May we contact your present employer(s)?
Yes
No
Are any of your relatives currently employed at Goodwill Industries?
If Yes,
Name: ______________________ Relationship: _________________
Yes
No
Yes
No
Yes
No
Name: ______________________ Relationship: _________________
Were you previously employed by this organization?
If yes,
Job title/location: _____________________/______________________
From: _____ _____ to _____ _____
mo
yr
mo
yr
Can you perform the essential functions of the job with or without reasonable
accommodation?
EMPLOYMENT HISTORY
CURRENT OR MOST RECENT EMPLOYER:
Employed from _________ to _________
Name of Employer: ______________________________
Starting Position: __________________
Street Address: _________________________________
Rate of Pay: $_______
FT PT
City, State, Zip: _________________________________
Name of Supervisor: _____________________________
Ending Position: __________________
Phone: (
Rate of Pay: $_______
)__________________________________
FT PT
Job Duties: ________________________________________________________________________
_________________________________________________________________________________
Reason for leaving: _________________________________________________________________
_________________________________________________________________________________
NEXT PREVIOUS EMPLOYER ACTIVITY:
Employed from _________ to _________
Name of Employer: ______________________________
Starting Position: __________________
Street Address: _________________________________
Rate of Pay: $_______
FT PT
City, State, Zip: _________________________________
Name of Supervisor: _____________________________
Ending Position: __________________
Phone: (
Rate of Pay: $_______
)__________________________________
FT PT
Job Duties: ________________________________________________________________________
_________________________________________________________________________________
Reason for leaving: _________________________________________________________________
_________________________________________________________________________________
NEXT PREVIOUS EMPLOYER ACTIVITY:
Employed from _________ to _________
Name of Employer: ______________________________
Starting Position: __________________
Street Address: _________________________________
Rate of Pay: $_______
FT PT
City, State, Zip: _________________________________
Name of Supervisor: _____________________________
Ending Position: __________________
Phone: (
Rate of Pay: $_______
)__________________________________
FT PT
Job Duties: ________________________________________________________________________
_________________________________________________________________________________
Reason for leaving: _________________________________________________________________
_________________________________________________________________________________
*FT = Full Time, PT = Part Time
ADDITIONAL INFORMATION
Please provide any additional information (experiences, skills, abilities and training) which may be
related to the job you are applying for. You should exclude information which would reveal racial,
ethnic, religious, sexual preference or political background or orientation.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
EMPLOYMENT REFERENCES: Please list persons we may contact for business references.
NAME
1)
2)
3)
TITLE
COMPANY
ADDRESS
PHONE
CERTIFICATION: Please read carefully before agreeing.
Interview: I understand that submitting an application is not a guarantee of an interview. I understand
that if called for an interview, I will be asked to sign this application.
AT WILL Employment: Company Rules and Regulations. I understand that if accepted for
employment, I agree to abide by Goodwill Industries rules, regulations and policies. I understand that I
can resign at any time and for any or no reason, and that Goodwill Industries may release me at any time
and for any or no reason. I understand that this AT WILL status cannot be modified except by written
agreement signed specifically for that purpose by the President/CEO of the company.
Overtime: I may be required to work overtime hours or hours outside a normally scheduled workday
or workweek.
References: I authorize Goodwill Industries to communicate with former employers, school officials
and persons named as references whom I hereby release from any liabilities or damages whatsoever
resulting from exchanges of such information. I understand that reference responses are confidential
and not available for my inspection. I understand that employment is contingent upon satisfactory
verification of previous employment, clearance for criminal record, and provision of required work
eligibility documents.
Correct and Complete Information: To the best of my knowledge, the information and the
statements I have made in this application are correct and complete. I understand that if employed,
false information provided in this application may result in immediate termination.
I Agree
APPLICANT NAME
DATE
_____________________________
________
Submit
Be sure you have completed all sections of this
application. Incomplete applications will be
rejected. This application will be active for 90
days. You may reapply after that time.
