CCD - Goodwill Sacramento Valley & Northern Nevada

CCDdavesmith2023-08-23T18:02:30+00:00

Criminal Conviction Disclosure

Legal Name (as it appears on your identification)

HR - CCD (Criminal Conviction Disclosure)

First Name

Middle Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Have you been convicted of a crime (misdemeanor and/or felony) in the past seven (7) years?

Date of Conviction #1

County of Conviction #1

Please provide a description of the conviction including the Penal Code number:

Do you have any other felonies?

Date of Conviction #2

County of Conviction #2

Please provide a description of the 2nd conviction including the Penal Code number:

Date / Time

Electronic Signature (type your name)

I understand that checking this box constitutes my legal signature confirming that I acknowledge and agree to the above.

Goodwill Industries^® Sacramento Valley & Northern Nevada
Our Business is Changing Lives

8001 Folsom Blvd.
Sacramento, CA 95826

Email us: [email protected]
Call us: (916) 395-9000

Thrift Store · Discount Store · Nonprofit Organization

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