Lubbock Goodwill Job Application

GOODWILL INDUSTRIES OF LUBBOCK, INC.

Application for Employment

MISSION: TO CREATE JOB OPPORTUNITIES FOR PEOPLE WITH BARRIERS TO EMPLOYMENT

PERSONAL DATA

Name:

Address:

City:

State:

Zip:

Phone:

E-mail:

Desired Position:

Full Time

Part Time

Drivers License:

Yes No

State:
Number:

Type
Exp:

Military Service:

Branch

Duties

Any friends/relatives now working for Goodwill?

Yes

Name:

Relation:

Personal References

1) Name of Reference:

2) Name of Reference:

Occupation:

Address:

City/State/Zip:

Phone:

Relationship:

How long known:

Education

Name & Location of School	Select Last Year Completed	Major Course	Diploma/Degree
High School
College/University
College/University
Business or Trade School

Attach resume:
ACCEPTABLE FORMATS: .doc, .wpd, .txt, .wks, .pdf

Goodwill Industries conducts background checks on its employees.

Please Note: Your application will be kept active for 60 days. If you have not been contacted by Goodwill Industries by the end of 60 days, you must re-apply if still interested in employment by Goodwill Industries.

Goodwill Industries of Lubbock, Inc. is an equal opportunity employer.

We Encourage People with Disabilities to Apply.

Are you legally authorized to work in the U.S.?:
(If hired, you will be required to provide proof of work authorization.)

Yes No

Are you at least 18 years of age?:

Yes No

Briefly describe skills you may have that you acquired in other employment or armed forces:

Have you ever been convicted of a crime (felony)?:

Yes No

If yes, give details:
(Convictions are not automatic bar to employment)

Do you have any other skills you wish to mention?

Are you presently employed?:

Yes No

If so, may we contact your present employer?:

Yes No

If hired, when would you be available?:

Employment History

Please list chronologically, beginning with most recent experience.

Employer:

Address/City:

From (MM/YYYY):

To (MM/YYYY):

Supervisor:

Phone:

Salary:

Type of Work:

Reason for Leaving:

Employer:

Address/City:

From (MM/YYYY):

To (MM/YYYY):

Supervisor:

Phone:

Salary:

Type of Work:

Reason for Leaving:

Employer:

Address/City:

From (MM/YYYY):

To (MM/YYYY):

Supervisor:

Phone:

Salary:

Type of Work:

Reason for Leaving:

Invitation to Identify for Affirmative Action Purposes

Goodwill Industries of Lubbock, Inc. is an equal opportunity employer.

VOLUNTARY APPLICANT CHARACTERISTIC DATA

Please provide the following information, which will be used only for internal tracking, statistical purposed and reporting to regulatory agencies. This information will be detached from your application and will in no way be used in consideration for employment. Goodwill Industries of Lubbock, Inc. is an Equal Employer and does not discriminate because of sex, race, color, disability, national origin or religion.

Gender:

Male

Female

Indicate The Appropriate Race/Ethnic Group:

How Were You Referred To This Job:

Please check if applicable.

1. Visually impaired	5. Orthopedic	9.Learning Disabled/Mental retardation
2. Hearing impaired	6. Absence/Amputation of a member	10. Epilepsy
3. Cerebral Palsy	7. Psychotic	11. Cardiac/circulatory
4. Arthritis	8. Behavioral (not substance abuse)	12. Head injury
13. Other

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