<p>Goodwill Industries of Greater Cleveland and East Central Ohio, Inc. 408 Ninth Street, SW, Canton, Ohio 44707-7799</p><p>GOODWILL VOLUNTEER APPLICATION Date </p><p>PERSONAL Name Last First Middle Address Street City State Zip Telephone Email SSN# </p><p>Position Desired In Case of Emergency, Notify: Name Address Telephone Relationship Who referred you to Goodwill? Professional Organizations, Hobbies, or Special Interests </p><p>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</p><p>MEDICAL HISTORY</p><p>Name and Address of Personal Physician </p><p>EMPLOYMENT HISTORY</p><p>Present or Last Employer City Position Title </p><p>REFERENCES (Names and Phone Numbers of Two)</p><p>1. 2. </p><p>Signature Guardian Signature</p><p>I.C.6 Rev. 08/27/09</p>