Southeastern Region Application

The Mission of Evansville Goodwill Industries, Inc., a not-for-profit 501(c)(3) organization, is to
provide quality vocational and developmental opportunities to people who are disabled and/or
disadvantaged in order to enhance their ability to achieve full participation in society.

It is the employer's policy that equal employment opportunities be available to all employees and applicants without
regard to race, sex, sexual orientation, gender identity, age, color, religion, national origin, participation in military service,
disability, genetic information or any other legally protected status.

Personal Information

Date (YYYY-MM-DD):*
Home Phone:*
Work Phone:
Referral Method?*
Pay Expected?*
Will you work overtime if asked? *
When will you be available to begin work?*
Have you ever applied for employment with us? :*
If yes, Month/Year and Location
Position Desired:*
Apart from absence for religious observance, are you available for full-time work?*
If no, what hours can you work?
Applicants will be required to verify employment eligibility as required by law, including completion of an I-9 form
Other special training, skills or licenses (languages, machine operation, etc.)


High School

Name and Location:*
Course of Study:*
Years Completed:*


Name and Location:(1)*
Course of Study:(1)*
Years Completed:(1)*

Graduate School

Name and Location:(2)
Course of Study:(2)
Years Completed:(2)

Other (Vocational, Technical, etc.)

Name and Location:(3)
Course of Study:(3)
Years Completed:(3)


Note: A conviction does not automatically mean that you will not be selected. What you were convicted of, and how long ago you were convicted, are important. Please give all the facts so that an informed decision can be made. If you are applying in Illinois, do not complete the convictions section.

Have you been arrested for or convicted of a crime that has not been expunged or sealed by a court, other than minor traffic violations? (Please include any arrests subject to plea bargaining or diversion programs which have not been expunged or sealed by a court).*
If yes, please explain:


(Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employment.)

Company Name:*
Address 1:*
Employed From (Month and Year):*
Weekly Pay (Start and Last):*
Name of Supervisor:*
State Job Title and Describe Work:*
Reason for Leaving:*

Company Name:(1)
Address 1:(1)
Employed From (Month and Year):(1)
Weekly Pay (Start and Last):(1)
Weekly Pay (Start and Last):(2)
Name of Supervisor:(1)
State Job Title and Describe Work:(1)
Reason for Leaving:(1)

Company Name:(2)
Employed From (Month and Year):(2)
Name of Supervisor:(2)
State Job Title and Describe Work:(2)
Reason for Leaving:(2)

Company Name:(3)
Employed From (Month and Year):(3)
Weekly Pay (Start and Last):(3)
Name of Supervisor:(3)
State Job Title and Describe Work:(3)
Reason for Leaving:(3)

May We Contact These Employers?*
If no, please list which employers you wish us not to contact and why.
Attach Resume:

File types accepted include: .doc, .docx, .pdf
FileĀ size must beĀ 2MB or smaller

Applicant Statement:*
Today's Date:*