GOODWILL VOLUNTEER APPLICATION Date

Goodwill Industries of Greater Cleveland and East Central Ohio, Inc. 408 Ninth Street, SW, Canton, Ohio 44707-7799

PERSONAL Name Last First Middle Address Street City State Zip Telephone Email SSN#

Position Desired In Case of Emergency, Notify: Name Address Telephone Relationship Who referred you to Goodwill? Professional Organizations, Hobbies, or Special Interests

EDUCATION Check Highest Grade Completed: Grade School High School College 1 2 3 4 5 6 7 8 1 2 3 4 1 2 3 4

MEDICAL HISTORY

Name and Address of Personal Physician

EMPLOYMENT HISTORY

Present or Last Employer City Position Title

REFERENCES (Names and Phone Numbers of Two)

Signature Guardian Signature

I.C.6 Rev. 08/27/09