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Goodwill Registration Application
First Name
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Last Name
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Email Address
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Phone Number
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Preferred method of Contact
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Are you a Goodwill Employee?
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County you reside in:
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Zip Code
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Household size
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Gender
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Birthdate
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Primary language
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Marital Status
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Citizenship Status
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Highest level of education
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Race/Ethnicity
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Race/Ethnicity
Black or African American
Caucasian or White
Asian
Middle Eastern/North African
Hispanic/LatinX/Latino
American Indian or Native American
Alaskan Native
Native Hawaiian or Pacific Islander
Other Race or Origin
Do any of the following apply to you?
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Do any of the following apply to you?
Criminal History
Dislocated Worker
Displaced Homemaker
Drug/Alcohol Abuse
Homeless
Immigrant
Incumbent Worker
Lacks Childcare
Lacks Transportation
Refugee
Returning Citizens
Underemployed
Unemployed
None
Other
Are you currently receiving an income or financial assistance?
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How did you hear about Goodwill's programs and services?
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If you chose Community Partner, Event, Flyer, or do not see your answer above, please type in the business/ organization name associated with selection.
What Goodwill programs or services are you interested in? (Check all that apply)
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What Goodwill programs or services are you interested in? (Check all that apply)
Help in finding a job
Community Resource (not listed above)
Direct Customer Services Professional certification
AI Essentials Training
Bridge to Technology
Certified Manufacturing Associate Training
Digital Skills Training
IBM SkillsBuild for Job Seekers
How would you like Goodwill Mission to help?
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I hereby authorize Goodwill of Western Missouri & Eastern Kansas to disclose my personal identifying information to obtain a consumer report for employment verification. This disclosure may be revoked by me at any time, except to the extent of the information that has already been disclosed. A request to revoke consent for disclosure must be submitted in writing to your program supervisor.
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Signature
Submit
