Applicant Data (Page 4 of 4) in pdf

References:

Please list two personal references who are not relatives or former supervisors

_____________________________________________________________________________________

Name

Address

Telephone

Occupation

Years Known

______________________________________________________________________________________________________

Name

Address

Telephone

Occupation

Years Known

Information to applicant – please read carefully before signing application:

Goodwill Industries of Northern Michigan, Inc. is an equal opportunity employer. Goodwill Industries of

Northern Michigan, Inc. does not discriminate in employment on the basis of race, color, religion,

national origin, citizenship status, ancestry, age, gender, sexual orientation, marital status, physical or

mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for

employment establishes any obligation for Goodwill Industries of Northern Michigan, Inc. to hire me. If I

am hired, I understand that Goodwill Industries of Northern Michigan, Inc. or I can terminate my

employment at any time for any reason, with or without cause and without prior notice. I understand

that no representative of Goodwill Industries of Northern Michigan, Inc. has the authority to make any

assurance to the contrary.

I attest with my signature below that I have given to Goodwill Industries of Northern Michigan, Inc. true

and complete information on this application. No requested information has been omitted. I authorize

Goodwill Industries of Northern Michigan, In. to contact references provided for employment reference

checks. I understand that if an offer of employment is extended to me, the offer is contingent upon an

acceptable criminal background check. If I have misrepresented or omitted any facts on this application,

and I am subsequently hired, my employment may be terminated.

I understand that if I am employed, I will be required to provide proof of eligibility to work legally in the

United States. Failure to provide appropriate documentation as listed on the Form I-9 Employment

Eligibility Verification within 3 days of employment may result in suspension or termination of

employment.

I understand that this application is current for only 60 days from the date of signature.

Signature of Applicant:___________________________________________Date____________________

Applicant Data Page 4