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

(Tab from field to field)

Company Name

Contact Name

Telephone

E-mail

NEW HIRE INFORMATION

Employee Name
Last 4 digits of SS#
Address
City, Town
State, Zip Code
Telephone
Start Date
Job Title
Hourly Wage
Number Hours Per Week
Permanent Position	YES NO
Temporary Position	How long?
Benefits	Health 401K/Pension NO BENEFITS