Goodwill Training Program Application

Your honest answer to these questions will assist Goodwill in determining what additional support or services, if any, that you may need to be successful in this program.

Which program are you applying for?

Application Date: (mm/dd/yyyy)

Last Name:

First Name:

Middle Initial:

Street Address (Residence):

City:

State:

Zip (Residence):

Phone

Email:

Gender:

Have you ever worked for Goodwill:

Marital Status:

Have you ever been convicted of a:

Misdemeanor?

Felony?

Have you recently been arrested for any matter for which you are on bail or on your own recognizance pending trial?

Educational Status (Check the highest level that you completed):

Do you have prior healthcare experience/security guard experience?

Citizenship documentation will be required?

How were you referred?

Date of Birth:

Age:

Are you currently enrolled in any type of school? If so where?

Are you currently working? If so where? How many hours per week and hourly rate of pay?

Please list any skills relevant to the healthcare industry/security guard history; Include any certifications, job titles and lenght of time?

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