Employment Application

Please complete this application in its entirety to be considered for employment. While we gladly accept resumes, they may not be used in lieu of a completed application. Attach additional sheets if more space is needed. Please print clearly and legibly. Do not forget to sign the application.

If you would like to print and fill out the application form here is a PDF version of the application form.

Please return completed applications to:

Goodwill Human Resources
1010 Green Acres Road
Eugene, OR 97408
(541) 345-1801


Date of Application:
Position Applied For:
Applying For: Full-Time Part-Time Full-Time or Part-Time
Telephone: Email Address:
Do you have the legal right to work in the United States? (Federal Law requires proof of identity and employment authorization for all new employees). Yes  No
Driver's License #: State: Class:
Have you ever worked for Goodwill Industries: Yes No If yes, when:
Do you have relatives/friends/roommates working for Goodwill Industries? Yes No If yes, name: Relationship:
On what date would you be available for work?
Where did you hear about this position?


  City, State List Diploma or Degree
High School/GED

Have you ever used any other name(s)? If yes, please list name(s) used:
Please describe specialized training or skills that you have that are relevant to this position:

Goodwill Industries is an equal opportunity employer. Goodwill Industries will not discriminate or tolerate discrimination against any employee or applicant in any manner prohibited by law. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-related medical condition or disability.

WORK HISTORY - Include ten years of employment history. List most recent to oldest.

Most Recent Employer - Are you currently employed with this employer? Yes No
If yes, may we contact? Yes No
Company: Type of Business Phone
Job Title: Employed From: To:
Job Duties
Reason for Leaving
Company: Type of Business: Phone
Job Title: Employed From: To:
Job Duties
Reason for Leaving
Company: Type of Business Phone
Job Title: Employed From: To:
Job Duties
Reason for Leaving
Company: Type of Business Phone
Job Title: Employed From: To:
Job Duties
Reason for Leaving
Please explain any gaps in your employment history:


Goodwill Industries has a zero-tolerance drug and alcohol policy. All job offers are contingent on passing a background check including a drug and alcohol test that includes screening for THC.

Are you willing to submit to drug and alcohol screening? Yes  No

If yes, are you able to pass drug screening? Yes  No

Do you understand the basic requirements needed to perform this job? Yes  No

Are you able to perform this job safely without significant risk of substantial harm to yourself or others? Yes  No You may answer YES if you can perform all essential functions of the job with or without reasonable accommodation.

Goodwill Industries will provide reasonable accommodation to a person with a disability. However, you are not required to identify yourself as a disabled person on this application form. If you need reasonable accommodations to perform the essential functions of the job then please respond to the following question: How would you perform the task, and with what accommodation(s)?


Retail employee work schedules include day, evening, weekend and holiday hours. All employees are expected to work as scheduled. Retail employees will typically include multiple evening shifts per week, weekends, and holidays as needed and determined by business need. Please indicate below the shifts you ARE able to work. Limited availability may preclude you from being considered.

I am able to work the following: Mornings Afternoons Evenings


Please list three professional references. Include only individuals familiar with your work ability. Do NOT include relatives or supervisors from work history listed above.

Name Address Telephone Relationship/Years Known

OUR MISSION: To provide vocational opportunities to individuals with barriers to employment.


By submitting this application, I declare the information provided by me is complete and true to the best of my knowledge. I understand that any misrepresentation or omission on this application may preclude an offer of employment or may result in a withdrawal of an employment offer or discharge from employment if I am already employed at the time the misrepresentation or omission is discovered.

In the event I undergo a medical examination or evaluation as part of the job placement process, I agree to supply only information which is true to the best of my knowledge and I authorize the physician or their representative to provide any information or opinion, as it relates to my employment, to Goodwill Industries. Regarding this examination or evaluation, I understand that if Goodwill Industries determines that I have made any false oral or written statements or answers or any misrepresentation or omission of significant information to Goodwill Industries or to the physician or to their representative, Goodwill Industries is entitled to terminate my conditional or actual employment at any time.

I authorize Goodwill Industries or its agents to verify any information on this application including, but not limited to references, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement agencies to release any information concerning my background, and release any said persons, schools, companies or agencies from any liability for issuing this information.

Additionally, I hereby authorize the release of the results of any drug testing to Goodwill Industries for their use in evaluating my suitability for employment.

Further, I release the examining facility and Goodwill Industries from any and all liability and from any damage that may result from the release of such information. I understand that the use of illegal drugs, marijuana and alcohol is prohibited during employment, and am willing to submit to drug testing to detect the use of illegal drugs, marijuana and alcohol prior to and during employment.

I understand that employment at Goodwill Industries is on an “at will” (that is, mutual consent) basis. Therefore, I agree that either I or Goodwill Industries has the right to terminate with or without cause at any time, so long as there is no violation of applicable state or federal laws.

 By checking the box and typing my name, I consent to the Agreement and Release

Applicant Name:

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