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Bismarck Area
Dickinson Area
Fargo Area
Grand Forks Area
Jamestown Area
Minot Area
Employee Testimonials
APPLICATION FOR EMPLOYMENT
Name
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
Are you legally eligible for employment in this country?
*
(Proof of U.S. citizenship or immigration status will be required upon employment)
Yes
No
Have you ever been convicted of a felony in the last five (5) years?
*
(Such conviction may be relevant if job related, but does not bar you from employment!)
Yes
No
Employment Desired
Position Desired
*
Select the position you are applying for.
Cashier/Processor
Donation Attendant
Position Location
*
Select the location for which you are applying.
Fargo
Start Date
Enter the date you wish to start employment.
MM
DD
YYYY
Desired rate of pay
Have you ever applied at Easter Seals Goodwill ND before?
Yes
No
If yes, Where? When?
Do you have a relative or significant other that works at Easter Seals Goodwill ND?
Yes
No
If so, who?
How did you hear about us?
How did you hear about us?
ESGWND website
Job Service ND
Social Media
Indeed
Job/Career Fair
Radio
Billboards
Shopping In-Store
Referral
Other
Employment History
List your last two (2) employers, assignments, or volunteer activities, starting with the most recent, including military.
Employer 1
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Title
Telephone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
Reason for Leaving
Hourly Rate/Salary Start and Final
Employer 2
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Title
Telephone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
Reason for Leaving
Hourly Rate/Salary Start and Final
Additional Comments
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
*
MM
DD
YYYY
Signature of Applicant
*
Typed name will serve as signature. Full signature may be required at time of interview or hire.
Thank you!