Program Eligibility Questionnaire

Goodwill Industries

Program Eligibility Questionnaire
PLEASE NOTE: This is not an employment application. This is an eligibility form to determine entry into one of Goodwill's Job Readiness and Community Programs.
Full Name*

First NameLast Name
Contact No.*

Area CodePhone Number
E-mail
How did you get to this form?*

FacebookIndeedGoogleOther
Are you over the age of 24?*

YesNo
Do you have a minor child in the home?*

YesNo
Are you lacking your GED or High School Diploma?*

YesNo
Are you involved with the Juvenile or Adult justice system?*

YesNo
Are you or have you been involved with the Foster Care System?*

YesNo
Are you homeless or a runaway?*

YesNo
Are you, your parents or guardians receiving cash benefits or PRC Funding?*

YesNo
Are you unemployed or underemployed?*

YesNo
Do you have 1 or more disabilities?*

YesNo
Are you working with another agency, or are you from another agency?*

YesNo
Please name the agency*
How did you learn about Goodwill's Programs?*

Ohio Means Jobs Computer Lab at Wayne County Department of Job and Family ServicesGoodwill WebsiteFacebookWalk inOther AgencySchool Counselor
Comments
Please verify that you are human*
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Goodwill Industries