Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you at least 18 years of age? *

Yes

No

Have you ever been employed here? *

Yes - Please answer next question

No

Do you have any relatives or friends who work for Goodwill Industries-Knoxville? *

Yes - Please answer next question

No

Type of employment desired *

Full time

Part time

Date available to begin work *

MM

DD

YYYY

Will you work overtime if required? *

Yes

No

Did you serve in the U.S. Armed Forces *

Yes - Please answer next question

No

Have you ever been convicted of a felony? *

Such conviction may be relevant if job related, but does not necessarily bar you from employment.

Yes - Please answer next question

No

Reference 1 Name *

First Name

Last Name

Reference 1 Phone Number *

(###)

###

####

Reference 2 Name *

First Name

Last Name

Reference 2 Phone Number *

(###)

###

####

Reference 3 Name *

First Name

Last Name

Reference 3 Phone Number *

(###)

###

####

Reference 4 Name

First Name

Last Name

Reference 4 Phone Number

(###)

###

####

Employer 1 Phone Number

(###)

###

####

Employer 1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

May we contact Employer 1 for reference?

Yes

No

Later

Employer 2 Phone Number

(###)

###

####

Employer 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

May we contact Employer 2 for a reference?

Yes

No

Later

Employer 3 Phone Number

(###)

###

####

Employer 3 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

May we contact Employer 3 for reference?

Yes

No

Later

Please read before submitting *

I certify that the information given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give Goodwill permission to contact schools, previous employers, references, and others, and hereby release Goodwill from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information requested in this application or pre-/post-hiring process may remove me from further consideration for employment. In addition, if employed, any misrepresentations or omissions of facts called for in this application/resume and pre-/post-hiring process will be causes for dismissal at any time without previous notice. This application will remain active for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety days of their original application should reapply. By submitting your application, you acknowledge and agree to the above.

I acknowledge and agree to these terms and conditions

As a government contractor, Goodwill Industries-Knoxville, Inc. is subject to Executive Orders 11246 and 12985, as amended; section 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974; Section 503 and 504 of the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990; and the Civil Rights Act of 1991. We request your voluntary completion of the following questionnaire to be used ONLY for the purpose of monitoring the success of our affirmative action plan. This information will not be used to discriminate against or show preference for any applicant in the hiring decision. Your immediate attention is requested. This information will be required upon employment.

I understand that this information is voluntary and will not be used to discriminate against or show preference for me in the hiring decision.

Your Name

First Name

Last Name

Sex

Male

Female

Birth Date

MM

DD

YYYY

US Citizenship

Yes

No

Other

Ethnic Data

Hispanic or Latino - a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race

White - Non-Hispanic or Latino

Black or African American - Non-Hispanic or Latino

Asian (Non-Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent (examples: Cambodia, China, India, Japan, Korea, Pakistan, the Philippines, Thailand, Vietnam.)

Native Hawaiian or Other Pacific Islander (Non-Hispanic or Latino) - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

American Indian or Alaskan Native (Non-Hispanic or Latino) - A person having origins of any of the original people of North and South America (including Central America) and who maintains a tribal affiliation or community attachment.

Two or More Races - All persons who identify with more than one of the above five Non-Hispanic or Latino races.

Veterans Data - Are you a Veteran?

Yes

No

If yes, please choose one of the categories below

Special Disabled Veteran - a person who is entitled to compensation under laws administered by the Department of Veterans Affairs for a disability rated at 30 percent or more; or, rated at 10 or 20 percent, if it has been determined that the individual has a serious employment disability; or, a person who was discharged or released from active duty because of a service-connected disability.

Disabled Veteran - a veteran who served on active duty in the U.S. Military ground, naval, or air service and is entitled to disability compensation (or who but for the receipt of military retired pay would be entitled to disability compensation) under laws administered by the Secretary of Veterans Affairs, or was discharged or released from active duty because of a service-connected disability.

Recently Separated Veteran - any veteran who served on active duty during the three-year period beginning on the date of such veteran's discharge or release from active duty.

Other Protected Veteran - any other veteran who served on active duty in the U.S. Military ground, naval or air service during a war on in a campaign or expedition for which a campaign has been authorized.

Armed Forces Service Medal Veteran - a veteran who, while serving on active duty in the U.S. Military ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg. 1209).

Referral Source

Walk-in

Government Employment Agency

Private Employment Agency

Employee

Relative

School

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Other (please answer next question)

*

It is the policy of Goodwill Industries-Knoxville, Inc. to provide a drug free workplace for all employees. Therefore, as part of this policy, we require that upon the contingent offer of employment that all candidates submit to urinalysis for the purpose of determining the drug content thereof. Once employed, all employees must submit to random drug screens. These tests will specifically screen for: amphetamines (speed, uppers), cannabinoids (marijuana), cocaine (coke, crack), phencyclidine (PCP, angel dust), and opiates (narcotics, heroin, morphine, etc.) By checking below, I agree that: I agree that a clinic partnering with Goodwill for pre-employment drug screens may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the company for analysis. If a positive result is obtained, applicants will be provided with the opportunity to provide the clinic with information regarding current prescriptions. I further agree to hereby authorize the release of the results of said tests to Goodwill Industries-Knoxville, Inc. I understand that it is the current illegal use of drugs and/or abuse of alcohol that prohibits me from being employed at Goodwill. I further agree to hold harmless Goodwill and its agents (including the above named physician or clinic) from any liability arising in whole or part out of the collection of specimens, testing, and use of the information from said testing in connection with Goodwill's consideration of my employment application. I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.

I have carefully read the foregoing and fully understand its contents. I acknowledge that by checking this box is a voluntary act on my part and that I have not been coerced into checking this box by anyone.