Community Service Volunteer Application Page 2
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4Do you have any relatives currently working for Goodwill? Yes____ No____
If yes, please list their name(s)________________________________________________
Are you able to perform the essential functions of the job with or without reasonable
accommodation? Yes____ No_____ If no, please explain___________________________
_______________________________________________________________________________________
Education: Circle last year completed: 4 5 6 7 8 9 10 11 12 College: 1 2 3 4
Other____________________________________________________________
Starting with your most recent employer, assignments or volunteer activities, provide the
following information.
Employer
Phone (
)
Street Address
City
State
Zip
___
Job Title
Supervisor’s Name ______________________
Start Date
End Date
Reason for Leaving
May we contact? Yes
No
___
Employer
Phone (
)
Street Address
City
State
Zip
___
Job Title
Supervisor’s Name ______________________
Start Date
End Date
Reason for Leaving
May we contact? Yes
No
___
Have you volunteered for Goodwill before? ___________ If yes, when? ________________
Have you been employed by Goodwill before? ________ If yes, when? _________________
Please list the person to contact in case of emergency:
Name_______________________________________ Phone________________________
Address___________________________________________________________________
Please list two references (non-family members):
Name______________________________________ Phone_________________________
Name______________________________________ Phone_________________________
Please list name of probation officer handling your case:
Name _____________________________________ Phone _________________________
Email Address ______________________________________________________________
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