Vocational & Community Services Referral
To be considered for On-the-Job Training (OJT) with Goodwill, you will need to register with the Division of Vocational Rehabilitation first. Goodwill Industries of Central Florida is one of the vendors with the Division of Vocational Rehabilitation. You can also submit a request by completing the form below and one of our employment specialists will assist you in the process.
Sign in to Google to save your progress. Learn more
Email *
Date *
MM
/
DD
/
YYYY
Original Referral Source *
Client Name *
Client Email *
Street Address *
City, State, Zip Code *
Social Security Number
Date of Birth *
MM
/
DD
/
YYYY
Age
Phone Number *
Disability (if applicable)
Please list any other medical conditions.
Is client currently taking medication? *
Functional Limitations *
Medicaid Recipient? *
SSI/SSDI Recipient? *
If receiving SSI/SSDI, please state amount.
Transportation *
Additional Comments
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms