Application for Employment

Equal Employment Opportunity Statement

Goodwest Industries LLC is an equal opportunity employer.  We are committed to a policy of equal employment opportunity.  We will recruit, select, hire, train, promote, and compensate associates on the basis of personal competence and potential for advancement without regard to race, color, religion, sex, national origin, age over 40, marital status, disability or citizenship as well as other classifications protected by applicable state or local laws.  Our equal employment opportunity philosophy applies to all aspects of employment with GoodWest LLC including recruiting, hiring, training, transfer, promotion, job benefits, pay, dismissal, and social and recreational activities.​

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Position Applying For:​*

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Desired Salary:​*

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Desired Shift:​

1st 7am – 3:30pm
2nd 3pm – 11:30pm
3rd 11pm – 7:30am
Willing to work other shift if desired shift is unavailable?

3am-3:30pm; 3 days a week plus every other Saturday
3pm-3:30am; 3 days a week plus every other Saturday

Date Available to Begin Work:​

Last Name:*

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First Name:*

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Middle Name:

Address:*

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City:*

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State:*

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Postal Code:*

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Primary Phone:*

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Secondary Phone:

Email:*

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Referral Source:

Social Security Number:*

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Date of Birth:*

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Are you a U.S. Citizen?​

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Are you legally authorized to work in the U.S.?​

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No

Are you 18 years of age or older?​

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No

Have you ever been convicted of a felony or misdemeanor?​

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No

If yes, please explain:

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If selected for employment are you willing to submit to a pre-employment drug screen?​

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No

If selected for employment, by checking yes on the box you are agreeing to submitting to a background check?​

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School Name:​

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Location:​

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Years Attended:​

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Degree Received:

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Major:

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Education

Other training, certification, licenses held, skills or qualifications:​

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work experience

Employer:

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Dates Employeed:

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Phone:

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Pay Rate:

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Supervisor:

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Address:

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State:

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Position:

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May we contact them?​

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Employer:

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Dates Employeed:

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Phone:

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Pay Rate:

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Supervisor:

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Address:

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City:

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Postal Code:

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Position:

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Reason for Leaving:

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May we contact them?​

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Duties Performed:

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Employer:

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Dates Employeed:

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Phone:

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Pay Rate:

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Supervisor:

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Address:

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Duties Performed:

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City:

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State:

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Postal Code:

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Position:

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Reason for Leaving:

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May we contact them?​

Yes
No

REFERENCES

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Reason for Leaving:

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ACKNOWLEDGEMENT AND AUTHORIZATION​*

By checking this box, I certify that all that all of the statements on this application form made by me are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I understand that any misrepresentation of information shall be sufficient cause for rejecting my application, withdrawing of any offer of employment, or terminating my employment.​

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