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

GOODWILL VOLUNTEER APPLICATION Date

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)

1. 2.

Signature Guardian Signature

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