Back to Work Form - MassHire South Shore Career Center

As part of our agreement with our business partners, we request information from your company/organization when you hire an individual.

Please Note: All information is strictly confidential, and all fields marked with a red asterisk (*) are required fields.

If you have any questions, please contact your Business Services Representative.

Company Name*
Contact Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
New Hire Information
Employee Name*
First Last
Last 4 of Social Security Number*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Start Date*
MM slash DD slash YYYY
Job Title
Hourly Wage
Number of hours per week
Full Time or Part Time*
- Full Time
- Part Time
Temporary Position?*
- Yes
- No
If temporary, how long?
Health Benefits?*
- Yes
- No
401K/Pension Plan?*
- Yes
- No
Other Benefits

New Hire Information