10596 Gandy Boulevard
St. Petersburg, FL 33702

16432 US Hwy 19 North
Clearwater, FL 33764

APPLICATION FOR EMPLOYMENT
WE ARE AN AFFIRMATIVE ACTION ANDJ
EQUAL OPPORTUNITY EMPLOYER AND A DRUG FREE WORKPLACE
Last Name
  First Name
  Middle Name
Date:
Select Date
Street Address
Last 4 digits of SSN
City
  State Zip
County
Home Phone
Position(s) Desired:(Will only accept
application for available position/one position
per application)

What date are you available to start?
Select Date
Expected Pay?
Business/Cell Phone

Email
GENERAL INFORMATION: This application must be fully completed to be considered for employment. Incomplete applications will not be accepted.
Can you perform the essential functions of the job for which you are applying either with or without reasonable accommodation?
(A copy of the job description for which you applied should be attached.
If not, please request a copy and review before answering this question.)      
Are you available to work full-time?
Are you available to work part-time?
Will you work overtime?
Will you work weekends?
Will you work evenings?
Will you work holidays?
What Days Can You Work? - Check All That Apply:  

What hours can you work?
Have You Ever Applied for Employment with Goodwill-Suncoast, Inc.?       If Yes, list dates and location
Dates:
Location:
Have You Ever Been Employed by Goodwill-Suncoast or any other Goodwill Industries?
     
If Yes, list dates and location
Dates:
Location:
Indicate Friends / Relatives Employed by Goodwill-Suncoast, Inc.
 
How Were You Referred to Suncoast Business Solutions?
Specify If Other

Are You 18 Years of Age or Older?

         
If NO, Can You Provide Required Proof of Your Eligibility to Work?

         
If Hired, Would You be Able to Present Evidence of Your United States
Citizenship or, Proof of Your Legal Right to Work in the United States?

         
 
Veteran Status: (choose the mostappropriate description)






I am of Hispanic/Latino origin           
Spanish is my primary language           
 

EMPLOYMENT HISTORY(Begin with the current or most recent employer and fully complete a section)
Company Name
Telephone
Full Address
From
Select Date
To
Select Date
Immediate Supervisor/Title
Starting Pay
Ending Pay
List Job Title and Description of Your Work
Reason for Leaving
Please Explain:
Company Name
Telephone
Full Address
From
Select Date
To
Select Date
Immediate Supervisor/Title
Starting Pay
Ending Pay
List Job Title and Description of Your Work
Reason for Leaving
Please Explain:
Company Name
Telephone
Full Address
From
Select Date
To
Select Date
Immediate Supervisor/Title
Starting Pay
Ending Pay
List Job Title and Description of Your Work
Reason for Leaving
Please Explain:
 
ADDITIONAL EMPLOYMENT INFORMATION
Please Explain Any Gaps in Your Employment History
 
Have You Ever Been Employed Under a Different Name?       

If Yes, List Names

We May Contact Employers Listed Above Unless You Indicate That You Do Not Want Us to Contact Them.
List the Employers You Do Not Want Us to Contact Here. Please Include Reason.
 
 


EDUCATION
School Type Name and Location Dates
Attended
Courses
Studied
No. of
Years
Attended
Did You
Graduate?
Degree /
Diploma
LIST ANY SKILLS/SPECIAL TRAINING THAT MAY BE USEFUL IN THE JOB BEING APPLIED FOR
Personal Computer(indicate type of software)
           
           
       
Revised 5/2018
 
DRIVING REQUIREMENTS
If the position requires the operation of Goodwill vehicles, transporting of consumers, or use of
personal vehicles for employment purposes, complete section relative to vehicle operation.
Your driving record will be checked with the Department of Motor Vehicles.
You must complete and sign a MVR form upon a job offer.
Driver's License No.   State   Class   Exp. Date Select Date
Within the Last 36 Months, Have You Had Any Auto Accidents or Moving Violations?        
If Yes, List Date(s) of All Accidents or Violations, Circumstances of Each (Include City and State) and Who Was at Fault (To Whom Citation Was Issued)
 
Have You Ever Received a Citation for DUI or Had Your License Suspended or Revoked?        
If Yes, Explain
 
 
CRIMINAL CONVICTION HISTORY

INSTRUCTIONS FOR CRIMINAL CONVICTIONS HISTORY

Criminal convictions or pleas will NOT automatically exclude you from consideration for employment. However, your misrepresentation of or failure to list ANY AND ALL criminal history records will automatically disqualify you from further consideration for employment and, if employed, will result in termination from employment at any time without notice.


YOU ARE STRONGLY ENCOURAGED TO REVIEW YOUR CRIMINAL HISTORY THOROUGHLY BEFORE SUBMITTING THIS APPLICATION TO AVOID ACCIDENTAL OMISSION OR MISREPRESENTATIONS THAT WILL DISQUALIFY YOU FOR EMPLOYMENT. JUVENILE CONVICTIONS OR PLEAS THAT HAVE NOT BEEN FULLY DROPPED, SEALED, OR EXPUNGED MAY APPEAR ON YOUR CRIMINAL HISTORY RECORDS.


Have You Ever Pled Nolo Contendere (No Contest), Entered a Pre-Trial Intervention Program, or a Similiar Program, Been Fined, or Placed on on Probation for a Misdemeanor or a Felony, Regardless of Adjudication?   

     
If Yes, Explain the Criminal Charge(s)
 
Have You Ever Been Convicted of a criminal traffic violation, misdemeanor or felony?
If yes, Specify the Criminal Charge(s) and Conviction.
(An Affirmative Answer Will Not Automatically Disqualify You for Employment.)
 
ACKNOWLEDGMENTS AND CONSENTS
I hereby certify that the answers contained herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give the agency permission to contact schools, previous employers, references, and others, and hereby release the agency and any persons whatsoever from any liability as a result of such contact. I understand that any misrepresentation or omission of facts in this application may disqualify me from further consideration for employment and, if employed, will subject me to dismissal at any time without previous notice.

I further understand that I may be subject to a criminal background check by local, state and / or federal law enforcement agencies and a background check by the Department of Children and Families.

I understand that my employment with the agency is for no specific term and may be terminated by me or the agency with or without notice at any time and for any reason. I further understand that no oral promise, agency policy, custom, business practice or other procedure constitutes an employment contract or modification of the at-will employment relationship between me and the agency.

The contents of any employee handbook or personnel manual, as well as other agency policies and practices, are subject to change or modification by the agency, solely at its discretion, without notice. I also understand that no supervisor or other official of the agency (except its president, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing.

We conduct our business with the highest possible degree of safety and efficiency. Because of this, the agency will require applicants for employment to undergo blood-alcohol, breath, and / or urine testing for drug or alcohol misuse. In addition, all employees of the agency are subject to blood-alcohol, breath, and / or urine testing pursuant to Department of Transportation and Worker's Compensation rules and regulations to include pre-employment, post-accident, reasonable suspicion, random, return-to-duty, and follow up testing.

Suncoast Business Solutions is an equal opportunity and affirmative action employer. We adhere to a policy of making employment decisions without regard to race, color, ancestry, age, sex, religion, national origin, ethnicity, sexual orientation, marital status, veteran status, handicap or disabled status.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signature Date: Select Date

NOTICE This application will remain active for ninety (90) days.
Any applicant wishing to be considered for employment beyond ninety (90) days must reapply.

 
GOODWILL INDUSTRIES-SUNCOAST, INC
St. Petersburg, Florida

VOLUNTARY SELF-IDENTIFICATION FORM OF RACE AND GENDER
For Affirmative Action Plan purposes, you are requested to voluntarily provide the information requested below. Failure to respond will in no way affect the application process.

Goodwill Industries-Suncoast, Inc. is an equal opportunity employer/disabled/veterans and is subject to certain reporting and affirmative action requirements. Qualified applicants are considered without regard to race, color, ancestry, ethnicity, religion, age, national origin, disability, veteran status, sexual orientation, or any other classification protected by federal, state or local law.

The information requested below is used by Goodwill-Suncoast to maintain records required of employer doing business with the federal government. In an effort to comply with such requirements, we invite you to complete this form. Providing this information is strictly voluntary and will not be used as a basis for employment decisions. A refusal to complete this form will not subject you to any adverse treatment. The information provided will be kept confidential as far as practicable and in accordance with federal laws and regulations. The information will be used for statistical reporting as required by governmental agencies. During the application, interview, and hiring processes, the information collected here is maintained separately from your application and is not considered by the hiring supervisor.
1.  Name (please print):
2.  Gender (please check):
3.  Please check one of the following Race/Ethnic Categories:

Signature

Date: Select Date
 

GOODWILL INDUSTRIES-SUNCOAST, INC.
St. Petersburg, Florida

INVITATION TO APPLICANTS
VOLUNTARY REQUEST TO SELF-IDENTIFY AS PROTECTED VETERAN

Name:   Date: Select Date

Goodwill-Suncoast is a government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. (VEVRAA), which requires government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently seperated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

  • A "disabled veteran" is one of the following:
  • (1) veteran of the U.S. military, ground, naval, or air service who is entitled to compensation (or but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
  • a person who was discharged or released from active duty because of a service-connected disability.
  • The term “Active Duty Wartime or Campaign Badge Veteran” means any veteran who served on active duty in the U.S. military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.

  • The term “Armed Forces Service Medal Veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded.
  • The term “Recently Separated Veteran” is defined as any veteran discharged or released from active duty in the past three years.

Protected veterans may have additional rights under the Uniformed Services Employment and Reemployment Rights Act (USSERA). In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Services(VETS), toll-free, at 1-866-4-USA-DOL.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Submission of this information is voluntary and refusal to provide a response will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistant with VEVRAA.

The information will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

If you are an applicant or new hire, please list your referral source:

 

GOODWILL INDUSTRIES-SUNCOAST, INC.
St. Petersburg, Florida

VOLUNTARY SELF-IDENTIFICATION OF DISABILITY

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral Palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular Dystrophy
  • Bipolar Disorder
  • Major Depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)
  • Please check one of the boxes below:


    Your Name
    Select Date
    Today's Date

    PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

    Reasonable Accommodation Notice
    Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

    Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCC) website at www.dol.gov/ofccp.


    PLEASE READ ALL OF THE CONSENTS AND ACKNOWLEDGEMENTS PROVIDED ABOVE CAREFULLY BEFORE SIGNING. BY TYPING YOUR NAME AND SUBMITTING YOUR APPLICATION, THE AUTHORIZATIONS, CONSENTS, AND ACKNOWLEDGEMENTS SPECIFIED IN THE ABOVE STATED PARAGRAPHS ARE FULLY BINDING AND ENFORCEABLE.

    Signature Date: Select Date