Home
Bismarck Area
Dickinson Area
Fargo Area
Grand Forks Area
Jamestown Area
Minot Area
Employee Testimonials
Menu
Street Address
City, State, Zip
701-663-6828
Your Custom Text Here
Home
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 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
Have you lived in North Dakota continuously for the last five (5) years?
Yes
No
If not, please explain
Are you 18 years or older?
*
Yes
No
Do you have a Bachelors Degree in Social Work or a related field?
*
Yes
No
Do you have any certifications or additional degrees?
Yes
No
If so, please list below
*
Please type N/A if this does not apply.
Employment Desired
Position Desired
*
Select the position you are applying for.
Program Coordinator
Position Location
*
Select the location for which you are applying.
Dickinson
Mandan
Minot
Jamestown
Fargo
Grand Forks
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?
How did you hear about this position?
*
ESGWND website
Job Service ND
Facebook
Indeed
Newspaper
Radio
Walk-In
Referral (please specify below)
Other (please specify below)
If referred by a current ESGWND employee, friend, or relative please list below.
Please type N/A if this does not apply.
Do you have a relative or significant other that works at Easter Seals Goodwill ND?
Yes
No
If so, who?
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
What days and times are you available to work?
*
Your availability is important to know so we can match you appropriately with the needs of the people we support. Please specify each day of the week you are able to work and specify A.M. or P.M. Please be as detailed as possible.
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!
