Goodwill of Central Virginia Goodwill Staffing Solutions
Application for Employment
Goodwill of Central Virginia and subsidiaries (“the Company”) are fully committed to ensuring equal opportunity to all
applicants and associates without regard to race, color, sex, religion, national origin, age, disability, veteran status, or any
other basis of discrimination prohibited by applicable local, state, or federal law.
Incomplete applications will not be considered.
Position(s) applying for: _____________________________ Date: ___ /___ /___
_____________________________
Personal Information
Last Name:
First Name:
Middle Initial:
Social Security #:
Home Phone:
Business Phone:
Street Address: __________________________________________
City, State, Zip: __________________________________________
E-mail Address: _________________________________________
Have you ever applied for employment with Goodwill of Central Virginia? ο No ο Yes
If “yes”, give dates: ______________________________
Have you ever been employed by Goodwill of Central Virginia? ο No ο Yes
If “yes”, give dates: ______________________________
Have you ever been convicted of, pled guilty to, or pled “no contest” to a crime (including, but not
limited to, DUI, DWI, etc.) in a court other than for a non-moving traffic violation? ο No ο Yes
If “yes,” please provide date and offense:
Are any criminal charges pending against you? ο No ο Yes
If “yes”, please explain:
____________________________________________________________________________________
____________________________________________________________________________________
Do you have any relatives working for Goodwill of Central Virginia? ο No ο Yes
Who? _____________________________
How did you hear about this job opening? Please be specific. If your source was a newspaper, list the
name of the newspaper: ___________