RETAIL PRODUCTION ASSOCIATE

Title : Retail Production AssociateLocation : Depew, NY* Batavia Buffalo Cheektowaga Clarence Depew Hamburg Lockport Niagara Falls North Buffalo Tonawanda West Seneca

APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION, *PLEASE READ CAREFULLY BEFORE SIGNING*

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate, and complete to the best of my knowledge.

I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee an employment opportunity. I further understand that, should an offer of employment be extended by Goodwill Industries of WNY, Inc.

that such employment with Goodwill Industries of WNY Inc., is at-will, with no specified duration and may be terminated by either Goodwill Industries of WNY, Inc.

or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements, or its representatives used during the employment process is deemed a contract of employment real or implied.

I understand that no representative of Goodwill Industries of WNY, Inc. has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President & CEO of Goodwill Industries of WNY, Inc.

I understand that if offered a position with Goodwill Industries of WNY, Inc., I may be required to submit to a pre-employment drug screening and background check as a condition of employment.

I understand that unsatisfactory result from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

I hereby authorize any and all schools, former employers, references, courts, and any others who have information about me to provide such information to Goodwill Industries of WNY, Inc.

and / or any of its representatives, agents or vendors.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ABOVE STATEMENTS. Equal Opportunity Employment We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired.

We appreciate your cooperation. Gender : Female

Male

I Choose Not to Respond Race / Ethnicity : American Indian or Alaska Native (Not Hispanic or Latino)A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment Black or African American (Not Hispanic or Latino)A person having origins in any of the Black racial groups of Africa Hispanic or LatinoA person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race Asian (Not Hispanic or Latino)A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam White (Not Hispanic or Latino)A person having origins in any of the original peoples of Europe, North Africa, or the Middle East Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands Two or More Races (Not Hispanic or Latino)All persons who identify with more than one of the above races I Choose Not to Respond Veteran Status : (Please check all that apply)Individual with a DisabilityAn individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.

• Vietnam Era VeteranA person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred;
• a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases;
• or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed;

a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.

Disabled Veteran1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs;

or 2) A person who was discharged or released from active duty because of a service-connected disability. War / Campaign / Expedition VeteranA 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.

Armed Forces Service Medal VeteranA 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 pursuant to Executive Order No.

12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.

Recently Separated VeteranAny veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U.

S. military, ground, naval or air service. I Choose Not to Respond