Application For Employment - Goodwill Industries Of Kanawha Valley, Inc. (Page 3 of 3) in pdf

School (Include City & State)

Years Completed

Completed

GPA/Class Rank

Major/Minor

______________________________ ___________

___________

_________

__ Diploma

__ GED

______________________________ ___________

__ Degree ________________

__ Certification _____________

__ Other ___________________

References

List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If

not applicable, list three school or personal references who are not related to you.

Name

Title

Relationship

Telephone

# of Years Known

to you

_________________________ _______________________

____________ (____)_________

________________

_________________________ _______________________

____________ (____)_________

________________

_________________________ _______________________

____________ (____)_________

________________

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this position is true, complete and correct.

I expressly authorize, without reservation, Goodwill Industries of Kanawha Valley, Inc., its representatives, employees or agents to

contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and

educational institutions and to otherwise verify the accuracy if all information provided by me in this application, résumé or job

interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives,

for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other

persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the

purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by local, state or federal

law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the

employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer

reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may

be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite

duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and

that no implied oral or written agreements contrary to the foregoing expressed language are valid unless they are in writing and signed

by the employer’s President/CEO.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States

and that Federal immigration laws require me to complete an I-9 Form in this regard.

Goodwill Industries of Kanawha Valley, Inc. does not tolerate unlawful discrimination in its employment practices. No

question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment

on the basis of sex, race, color, religion, national origin, citizenship, age, disability or any other protected status under

applicable Federal, State, or Local Law. Goodwill Industries of Kanawha Valley, Inc. does not tolerate harassment based on

sex, race, color, religion, national origin, citizenship, age, disability or any other protected status. Goodwill Industries of

Kanawha Valley, Inc. takes all complaints of harassment seriously and call complaints will be investigated promptly and

thoroughly.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will

be sufficient cause to (i) eliminate me from further employment consideration, or (ii) may result in my immediate discharge

from the employer’s service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant _________________________________________________ Date: _____________________________

Goodwill Industries of Kanawha Valley, Inc

Confidential Proprietary Applicant Document

Application For Employment - Goodwill Industries Of Kanawha Valley, Inc. Page 3

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