Virtual Job Connection Center Request for Services
Goodwill Job Connection Centers are now serving you virtually! Please complete the following information and a member of our Virtual Team will contact you for job search assistance and/or to connect you to community resources.
Sign in to Google to save your progress. Learn more
Email *
First and Last Name/ Nombre y Apellido *
Date of Birth/Fecha de Nacimiento (Mes,Día,Año) *
Last 4 of your Social Security number/Ultimos 4 digitos del Seguro Social *
Gender/Género *
What is your zip code? *
What county do you live in?¿En que Condado resides? *
Phone number (xxx) xxx-xxxx/Número de Teléfono *
Primary Language/ Idioma principal *
Have you ever served in the US Military?¿Servistes o sirves en las Fuerzas Armadas de los Estados Unidos? *
Ethnicity/Etnicidad *
Race/Raza *
How you hear about us?¿Como te enterastes de nuestros servicios? *
Do you have reliable transportation?¿Tienes transportación? *
Do you have a Disability?¿Tienes alguna incapacidad? *
Highest Level of educational attainment/Nivel de Educación *
Have you ever been convicted of a felony or misdemeanor?  ¿Haz sido convicto? *
Are you authorized to work in the U.S? ¿Estás autorizado a trabajar en los E.U.? *
How can we assist you?¿Como te podemos asistir? *
What other services you are looking for?  ¿Qué otros sevicios te interesa te encontrar? *
Are you a current or former employee of Goodwill Industries of Central Florida? ¿Eres o fuistes empleado de Goodwill? *
Were you recently laid-off or furloughed due to the COVID-19 situation? ¿Covid afectó tu situación de trabajo?
Clear selection
If in need of community resources, what type of assistance do you need (i.e. financial, housing/rent, utilities, childcare, healthcare, food)?¿Que tipo de asistencia de recursos en la comunidad estas necesitando?
If looking for a job, what type of work are you looking for? ¿Qué tipo de trabajo estas buscando?
Please tell us about your situation and how we may help.  Explicanos tu situación para ayudarte mejor.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy