Good Life Solutions Interest Form

2. First Name*
3. Last Name*
5. Street Number*
6. Street Name*
7. Street Type*
8. Apt #
10. City*
11. State*
12. ZIP
14. Home Phone
15. Cell Phone
16. Email*
18. Current Education Year*
19. Area of Interest*
21. List any courses relevant to the job opportunity you are seeking:
23. Have you been employed during the past 6 months?
25. Dates Employed:
27. From:
28. To:
30. Employer:
31. Position Title:
33. Address (Street, City, State, Zip Code):
35. Supervisor Name:
36. Supervisor Phone Number:
37. Supervisor Title:
39. Hours per week:
40. Salary:
41. May we contact this employer?

    1. Yes
    2. No
43. Duties
45. Reason for leaving:
47. List any other paid or unpaid work experience as it relates to the job you are seeking:
49. List other training, qualifications, and special interests (licenses, skills with machines, publications, memberships in professional or scientific societies):
51. Number of hours required to fulfill education program requirements (if applicable):
52. Schedule availability / preference (list days and times):*
54. Are you currently employed by the City of Newport News?*

    1. Yes
    2. No
55. Do you currently have any relatives working for the City of Newport News?*

    1. Yes
    2. No
57. Relative's Name, Relationship, and Department
59. Please provide your current GPA:
61. You may attach an electronic version of your resume:
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field