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Application For Employment

Name *
Name
Address *
Address
Phone *
Phone
How did you hear about us?
Are you 18 years of age or older? *
Are you legally eligible for employment in this country? *
(Proof of U.S. citizenship or immigration status will be required upon employment)
Have you ever been convicted of a felony in the last seven (7) years? *
(Such conviction may be relevant if job related, but does not bar you from employment!)
Have you lived in North Dakota continuously for the last five (5) years?
Have you ever been charged with abuse and/or neglect? *
Employment Desired
Are you employed now?
May we contact your employer?
Have you ever applied to Easter Seals Goodwill ND before?
Do you have a relative or significant other that works at Easter Seals Goodwill ND?
Education
Name and Location of School
Did You Graduate?
Name and Location of School
Did You Graduate?
Name and Location of School
Did You Graduate?
Employment History
List your last three (3) employers, assignments, or volunteer activities, starting with the most recent, including military.
Start Date
Start Date
End Date
End Date
Telephone
Telephone
Address
Address
Start Date
Start Date
End Date
End Date
Telephone
Telephone
Address
Address
Start Date
Start Date
End Date
End Date
Telephone
Telephone
Address
Address
Start Date
Start Date
End Date
End Date
Telephone
Telephone
Address
Address
Professional References
Address
Address
Home Telephone
Home Telephone
Work Telephone
Work Telephone
Address
Address
Home Telephone
Home Telephone
Work Telephone
Work Telephone
Address
Address
Home Telephone
Home Telephone
Work Telephone
Work Telephone
Verification of Information
It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. I GIVE THE EMPLOYER THE RIGHT TO INVESTIGATE ALL REFERENCES AND TO SECURE ADDITIONAL INFORMATION ABOUT ME, IF JOB RELATED. I HEREBY RELEASE FROM LIABILITY THE EMPLOYER AND ITS REPRESENTATIVES FOR SEEKING SUCH INFORMATION AND ALL OTHER PERSONS, CORPORATIONS, OR ORGANIZATION FOR FURNISHING SUCH INFORMATION.
Typed name will serve as signature. Full signature may be required at time of interview or hire.
Date *
Date
Hours of Availability
Please note what days and hours you are available to work.
Sunday (AM) *
Sunday (AM)
From:
Sunday (AM) *
Sunday (AM)
To (AM):
Sunday (PM) *
Sunday (PM)
From:
Sunday (PM) *
Sunday (PM)
To:
Monday (AM) *
Monday (AM)
From:
Monday (AM) *
Monday (AM)
To:
Monday (PM) *
Monday (PM)
From:
Monday (PM) *
Monday (PM)
To:
Tuesday (AM) *
Tuesday (AM)
From:
Tuesday (AM) *
Tuesday (AM)
To:
Tuesday (PM) *
Tuesday (PM)
From:
Tuesday (PM) *
Tuesday (PM)
To:
Wednesday (AM) *
Wednesday (AM)
From:
Wednesday (AM) *
Wednesday (AM)
To:
Wednesday (PM) *
Wednesday (PM)
From:
Wednesday (PM) *
Wednesday (PM)
To:
Thursday (AM) *
Thursday (AM)
From:
Thursday (AM) *
Thursday (AM)
To:
Thursday (PM) *
Thursday (PM)
From:
Thursday (PM) *
Thursday (PM)
To:
Friday (AM) *
Friday (AM)
From:
Friday (AM) *
Friday (AM)
To:
Friday (PM) *
Friday (PM)
From:
Friday (PM) *
Friday (PM)
To:
Saturday (AM) *
Saturday (AM)
From:
Saturday (AM) *
Saturday (AM)
To:
Saturday (PM) *
Saturday (PM)
From:
Saturday (PM) *
Saturday (PM)
To: