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  • Workforce Member Intake Form

  • Basic Information

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  • Digital Connectivity

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  • Emergency Contact Information

    Please give us contact information for at least one person that will always know how to find you.
  • Emergency Contact 1:

  • Emergency Contact 2:

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  • Employment and Education

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  • Military Veteran Experience

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  • Household Information

  • Financial Wellness

  • Savings

    Please check the answer you feel is most appropriate
  • Income Level

  • Income Supports

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  • Health and Well-Being

  • Health Care

  • Health Status

  • Work and Life Supports

  • Food Security

  • Housing Stability

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  • Transportation Access

  • Recidivism

  • Legal Issues

  • Family Care

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  • Clothing

  • Please Check All That Apply and Explain Below

  • Credit Score

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  • Financial Capability

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  • Financial Capability Score

    (to be completed by Goodwill Houston Associate)
  • Self-Efficacy

    Select the answer that better describes you.
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  • Self-Efficacy Score

    (to be completed by Goodwill Houston Associate)
  • Grit

    Select the answer that better describes you.
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  • Grit Score

    (to be completed by Goodwill Houston Associate)
  • Clear
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  • This is a fill in the field. Please add appropriate fields and text.

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