Last Name:   First Name:
Middle:   Address:
City:   State:    Zip:   Phone:
Social Security #:   Position Desired:
Salary Expected:   Select One: Full-Time  Part-Time  Either
Date Available:   Referred by:
Education (Highest Grade Completed):   School Name:
Year Graduated:   Degree:   Major/Minor:
Special Training:   Where:

Any other information regarding your education or training?

Employment History:  (Most Recent Job First)

Company Name:   Address:
Phone:   Supervisor:  
Job Title:   Dates of Employment:
From:   To:   Ending Salary:  
Reason for Leaving:
Length of Employment:

Company Name:   Address:
Phone:   Supervisor:  
Job Title:   Dates of Employment:
From:   To:   Ending Salary:  
Reason for Leaving:
Length of Employment:

Company Name:   Address:
Phone:   Supervisor:  
Job Title:   Dates of Employment:
From:   To:   Ending Salary:  
Reason for Leaving:
Length of Employment:

Any other comments you care to share about your work history?


Military Service?  Yes  No   Branch:   Years Served:

Do you have a current driver's license? Yes  No  Number:
State:   Type:   Expiration Date:

Have you previously worked for Goodwill?   Yes  No  When?
What department or retail store? 

Are you a U.S. Citizen?  Yes  No    If No, Alien ID#:

As an adult, have you ever been convicted of a crime?  Yes  No
If yes, please list all offenses, dates, and name of court disposition.
(You may omit any violations which a fine was paid $50 or less)
Please list all offenses:

Is there anything else that you feel is pertinent to this application?

I hereby certify that the information given or contained in this application is correct to the best of my knowledge and that it is given of my own free will.  I understand that this information will be checked and that any falsification of information on this application will constitute grounds of unfavorable consideration or dismissal if I am hired.

Name:   Date: