Quincy Career Center Back to Work Information Form

Quincy Career Center
152 Parkingway
Quincy, MA 02169
Phone: 617-745-4046
Fax: 617-745-4049

Back to Work Information

As part of our agreement with Employers, we request information from your company/organization when you hire an individual. The Quincy 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*: 
Phone*: 

New Hire Information

Employee Name*: 
Last 4 digits of SS#*: 
Address : 
City/Town: 
State: 
Zip Code: 
Phone: 
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
Verification*:
The verification process helps eliminate spam submissions
five - one =
  

If you have any questions, please contact:
Fran Grey, Career Center Manager
617-745-4046