Goodwill Registration Form

Goodwill Registration Form

Thank you for your interest in Goodwill supporting you to discover your potential and adapt for the future through the power of work. All Goodwill programs and services are available at no cost. Please enter your contact information below and our team will be in contact with you soon to get started.
Name*

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Head of Household*

YesNo
Birthdate

MonthDayYear
Date
How did you hear about Goodwill? Or who referred you?
Are you a Goodwill employee?*
If you are a Goodwill employee, please select your location:
Marital Status*
Citizenship Status*
Permission to send text messages*
Preferred Method of Contact?
Gender*
Other Gender
Do you identify with the LGBTQ+ community*
Primary Language*
Other Language
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Race/Ethnicity*

Black or African AmericanCaucasian or WhiteTwo or more racesMiddle Eastern/North Africa/Arab WorldAmerican IndianAlaskan NativeAsianNative HawaiianPacific IslanderHispanic/Latin X/LatinoNative AmericanSamoanOther
Military History (Please check all that applies)

History of MilitaryCaregiver of Person with Military HistoryHas Documented DisabilitiesDisabilities Service ConnectedFamily Member of Person with Military HistoryMilitary Service Documented
Highest level of education?

No Diploma or GEDHigh School DiplomaGED/HISETVocational Tech CertificateCollege Degree
Education/certificate or degree type?
Current desired positions or industries?
What is your career goal?*
Are you seeking?

Full TimePart TimeTemporaryOther
What is your shift availability?

1st Shift2nd ShiftOver Night ShiftOther
Do you need benefits?

YesNo
Desired hourly wage?
Are you currently working?

YesNo
If currently working, current wage?
If working, how many hours per week?
What Goodwill programs or services are you interested in? (Check all that apply)*

Certified Manufacturing Associate (CMfgA) Certification CourseBridge to TechnologyIntro to WeldingForklift and OSHA 10Grow with Google Certifications (UX Design, Project Management, Data Analytics, IT Automation with Python, IT Support)IBM SkillsBuild for Job SeekersFacebook Social Media Marketing CertificationDigital Skills TrainingReentry ServicesHelp finding a jobHelp getting a device (laptop, tablet)Help getting connected to the internetGetting a job at GoodwillOther Community Resources (not listed above)Other
Please describe any questions, comments or other support services needed.
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