Application For Employment

We do not discriminate on the basis of race, color, national origin, age, sex, gender, marital status, disability, sexual orientation, religion, family status, filing of a workers’ compensation claim, or any other legally protected status. It is our intention that all applicants be given equal opportunity and that selection decisions are based on job related factors.

Any individual who needs accommodation or assistance in completing an application for employment at any time during the application process should inform the Human Resources Department at (503) 238-6100. Each question should be fully and accurately answered. No action can be taken on this application unless all questions have been answered and the application signed.

First Name

Middle Name

Last Name

Date / Time

Present Address

City

State

Zip Code

Email

Phone/Mobile:

Job(s) Applied For (Please Specify):

Job location:

Can you perform the essentials functions of the job with or without reasonable accommodation?

Yes

No

Were you referred by someone?

Yes

No

Referred by:

Employment you are seeking:

Full-Time

Part-Time

When are you available for employment?

Are you 16 years of age or older?

Yes

No

Are you authorized to work lawfully in the United States? If hired, a Form I-9, Employment Eligibility Verification, must be completed at the start of employment.

Yes

No

Have you ever applied at Goodwill Industries of the Columbia Willamette?

Yes

No

If Yes, when?

Where?

Were you ever offered a position at Goodwill Industries of the Columbia Willamette?

Yes

No

If Yes, when?

Where?

If applying for a job that requires driving, do you have a valid Driver's License?

Yes

No

If hired by GICW, do you expect to engage in any other business or employment at the same time?

Yes

No

If Yes, please explain:

Have you had any educational, vocational, technical, or military training which you would like us to consider in reviewing your qualifications for the job applied for?

Beginning with your most recent employer, list all employment including military service and self-employment for the last ten years. Please account for all periods of unemployment. All sections of this application must be complete even if a resume is attached.

If presently employed, may we contact your present employer for references?

Yes

No

Present or Most Recent Employer:

Address:

City

State

Zip Code

Phone/Mobile:

Title/Duties:

Reason for leaving:

Explain:

Start Date:

End Date:

Name of Contact Person:

Previous Employer:

Address:

City

State

Zip Code

Phone/Mobile:

Title/Duties:

Reason for leaving:

Explain:

Start Date:

End Date:

Name of Contact Person:

Previous Employer:

Address:

City

State

Zip Code

Phone/Mobile:

Title/Duties:

Reason for leaving:

Explain:

Start Date:

End Date:

Name of Contact Person:

Previous Employer:

Address:

City

State

Zip Code

Phone/Mobile:

Title/Duties:

Reason for leaving:

Explain:

Start Date:

End Date:

Name of Contact Person:

Previous Employer:

Address:

City

State

Zip Code

Phone/Mobile:

Title/Duties:

Reason for leaving:

Explain:

Start Date:

End Date:

Name of Contact Person:

List ALL previous names, assumed names (aliases) or nicknames and maiden name, if applicable:

List all CITIES and STATES that you have lived in for the past 10 years:

I certify that the answers given by me to the foregoing questions and statements and any subsequent questionnaires, including a medical history questionnaire, are true and correct without omissions of any kind whatsoever. I understand and agree that all of the information I provide on this application form and subsequent questionnaire forms may be checked and verified by Goodwill Industries of the Columbia Willmette (GICW) and I agree and consent to such verification and background check. I agree that the company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me on this or any subsequent questionnaires. I also authorize the companies, schools or persons named above to give GICW any information regarding my employment, character and qualifications. I hereby release said companies, schools or persons named above from all liability for any damage from issuing this information. I understand that any false, misleading, or incorrect statements or omissions may render this application void, and if employed, may be cause for termination. GICW requires all job applicants to complete and pass drug test and background check if a conditional offer of employment is extended. I further understand that GICW is an "employment at will" employer.

I certify that the information provided on this application is accurate.

Attach Resume (not required)

If you attach a resume, you may be referred to our Job Connection program to assist in your job search.

Choose File

GOODWILL INDUSTRIES OF THE COLUMBIA WILLAMETTE EEO/AFFIRMATIVE ACTION SURVEY

It is the policy of Goodwill Industries of the Columbia Willamette to provide equal opportunity to all people without regard to race, color, creed, national origin, age, sex, disability, or marital status and to promote the full realization of that policy through a positive continuing program to be known as the Goodwill Industries of the Columbia Willamette Affirmative Action Plan.

As employers/government contractors, we comply with government regulations and affirmative action responsibilities.

In order to help us comply with government record keeping, reporting, and other legal requirements, please fill out the EOO/Affirmative Action Survey. Submission of information is voluntary. We appreciate your cooperation. This data is for periodic government reporting and will be kept in a confidential file separate from the Application for Employment.

Date:

Position(s) Applied For:

Phone:

First Name:

Middle Name:

Last Name:

Address:

City

State

Zip Code

Government agencies require periodic reports on the sex, ethnicity, and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information is voluntary.

Gender

Male

Female

Are you a veteran?

Yes

No

Vietnam Era?

Yes

No

Were you referred by someone?

Yes

No

Referral source: