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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
Select the position you are applying for.
Select the location for which you are applying.
Start Date
Start Date
Enter the date you wish to start employment.
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
Hours of Availability
Please note what days and hours you are available to work.
What time can you start working on Sundays?
What time do you need to be done working on Sundays?
What time can you start working on Mondays?
What time do you need to be done working on Mondays?
What time can you start working on Tuesdays?
What time do you need to be done working on Tuesdays?
What time can you start working on Wednesdays?
What time do you need to be done working on Wednesdays?
What time can you start working on Thursdays?
What time do you need to be done working on Thursdays?
What time can you start working on Fridays?
What time do you need to be done working on Fridays?
What time can you start working on Saturdays?
What time do you need to be done working on Saturdays?
Please indicate any other availability or scheduling concerns below.
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.
Date *
Date
Typed name will serve as signature. Full signature may be required at time of interview or hire.