Plymouth Career Center Back to Work Information Form

Plymouth Career Center
36 Cordage Park Circle
Suite 200
Plymouth, MA 02360
Phone: 508-732-5300
Fax: 508-747-0631

Back to Work Information

As part of our agreement with Employers, we request information from your company/organization when you hire an individual. The Plymouth Career Center requires accurate up-to-date information in order to continue to provide the ability of others to utilize our services. Thank you for your cooperation.

All Information Is Strictly Confidential!

Please Note: All fields marked with a red asterisk (*) are required fields.

Company Name*: 
Contact Name*: 
Email Address*: 

New Hire Information

Employee Name*: 
Last 4 digits of SS#*: 
Address : 
Zip Code: 
Start Date*: 
Job Title*: 
Hourly Wage*: 
# of Hours per Week*: 
Full Time/Part Time: 
Temporary Position: 
If Temporary, How Long?: 
Health Benefits?: 
401K/Pension Plan?: 
Other Benefits?: 
Yes No
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If you have any questions, please contact:

Jacquie McLellan, Business Services Representative
Ashley Terrill, Business Services Representative