Job Application

GOOD SAMARITAN MINISTRIES AND THRIFT STORE is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, or physical or mental disability.

Phone

Personal Information

Last Name *

Middle Initial

First Name *

Other Names/Aliases

Social Security No. *

Driver’s License No.

Address

Home Phone

Business/Messaging Phone

Referred By:

Desired Salary:

Have you ever INTERVIEWED with Good Samaritan Ministries and Thrift Store before? *

Yes

If yes, please list date(s) job title(s) and location(s)

Have you ever been EMPLOYED by Good Samaritan Ministries and Thrift Store before? *

Yes

If yes, please list date(s) job title(s) and location(s)

Do you have any relatives employed by Good Samaritan Ministries and Thrift Store? *

Yes

If yes, please list name(s), date(s) job title(s) and location(s)

Education

Enter your highest grade completed

High School: 9, 10, 11, 12 — College, Trade, or Business: 1, 2, 3, 4, — Or Graduate Studies *

If you have graduate level education experience, please describe it here:

High School Name

Address

Major Studies

Graduated?

Yes

College Name – Undergrad

Address

Major Studies

Degree, License, or Certificate

College Name – Grad. Studies

Address

Major Studies

Degree, License, or Certificate

Vocational School Name

Address

Major Studies

Degree, License, or Certificate

Do you speak any language other than English?

Foreign Language 1

Fluent?

Yes

Foreign Language 2

Fluent?

Yes

For Clerical Applicants only:

Do You Type?

Yes

If yes, WPM:

Employment History

List employment history for the past 5 years, starting with the most recent position. All information must be completed. You may send us a resume at [email protected], but not in place of completing the required information.

Employer Name

Employer Address

Job Title

Start Date

End Date

Duties and Responsibilities

Supervisor Name

Supervisor Phone #

Starting Salary

Ending Salary

Reason For Leaving

Employer Name

Employer Address

Job Title

Start Date

End Date

Duties and Responsibilities

Supervisor Name

Supervisor Phone #

Starting Salary

Ending Salary

Reason For Leaving

Employer Name

Employer Address

Job Title

Start Date

End Date

Duties and Responsibilities

Supervisor Name

Supervisor Phone #

Starting Salary

Ending Salary

Reason For Leaving

Military History

Did You Serve in the U.S. Armed Forces?

Yes

If Yes, Which Branch?

Describe any training received that is relevant to the position you are applying for:

General Questions

Contact

Yes

May we contact your current employer for references?

Work Overtime

Yes

If hired, will you be able to work overtime?

Able To Perform

Yes

Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accomodation?

Criminal Conviction

Yes

Have you ever pled “guilty” or “no contest” to, or been convicted of a crime? If yes, please
provide date(s) and details in the space below.

Answering “yes” to the following question does not constitute an automatic bar to employment. Factors such as date of the offense,
seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account.

Criminal Conviction Details

References

Give the names of three professional references that are NOT related to you, whom you have known at least one year.

#1. Name

Phone

Address

#2. Name

Phone

Address

#3. Name

Phone

Address

Certification and Autorization

The above information is true and correct. I understand that, in the event of my employment by Good Samaritan Ministries and Thrift Store, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.

I authorize Good Samaritan Ministries and Thrift Store to inquire into my past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to Good Samaritan Ministries and Thrift Store and will hold Good Samaritan Ministries and Thrift Store and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information.

I understand that nothing in this employment application, the granting of an interview, or my subsequent employment with Good Samaritan Ministries and Thrift Store is intended to create an employment contract between myself and Good Samaritan Ministries and Thrift Store under which my employment could be terminated only for cause. On the contrary, I understand and agree that, if hired; my first 6 months of employment are “at will” during which time I may be terminated with or without cause as long as not illegal or against Good Samaritan Ministries and Thrift Store policy.

Good Samaritan Ministries and Thrift Store believes that all employees have a right to work in a drug-free and alcohol-free environment in keeping with the Drug-Free Workplace Act of 1998. Good Samaritan Ministries and Thrift Store may conduct random, post incident/accident, reasonable suspicion drug screening. Policy will be signed upon hire.

In addition, a criminal background check is required for employment at Good Samaritan Ministries and Thrift Store.

Applicant Initials *

Certification

I hereby acknowledge that I have read and agree to the above statements

Applicant Name – Printed *

Date *