Job Connections Welcome Form
The Job Connections Program is a free service to assist you in gaining the skills and resources necessary to find a job, keep a job, or get a better job and move toward increasing your income potential to a family sustaining wage and economic stability. Please complete this required form.
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Email *
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First & Last Name *
Today's Date *
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Job Connections Location *
Street Address *
City/State/Zip *
Last 4 of SSN: *
Date of Birth *
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Phone number *
Gender *
Ethnicity *
Required
Citizenship *
Family Status *
Do you have dependents living with you?
Active Military? *
History of Military Service? *
Do you have a documented Military Service connected disability?
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Family member of a person with History of Military Service: (If yes, what relationship?) *
Are you a caregiver of a person with history of Military Service? *
How did you hear about Job Connections/ Prosperity Program? How were you referred? *
Required
Are you receiving any of the following? *
Required
Form of Transportation: *
Highest Education Completed: *
Please check any of the below that apply to you: *
Required
Do you have any health issue or medical history that may impact your job search/ employment?
Do you have a physical, mental, or learning disability? If yes, what is your disability?    
Are you currently or have you ever been in alcohol or drug treatment?
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Do you have criminal history? If yes, please explain (Note felony/misdemeanor, dates, etc.)   *
Currently on parole/probation? If yes, until when?
What has made it difficult for you to obtain or keep employment?   *
Follow-Up Contact Release Statement                 Goodwill Industries periodically contacts employers once a participant has a job to confirm employment status. This information is of vital importance in helping Goodwill Industries provide quality services. By signing below, you will help us quality check our services and keep our program going to help others find employment.I understand that Goodwill staff may seek to gather follow-up information after Job Connections/Prosperity Program services have ended. I grant Goodwill my permission to gather follow-up data. *
Required
Are you looking for work? *
What is your current job status? *
Required
Desired job status: *
Desired hourly wage:
Desired weekly hours:
Availability start date:
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Desired Location (check all that apply): *
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Please select up to 5 jobs below that you have the skills and experience to perform: *
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