Got a job or new career? Tell us about it!

Back to Work Form

If you have found employment, Congratulations! We appreciate you providing information so we may continue to receive federal funding for our programs. We will also update your records so that we will not continue to contact you for future events unless you want us to.

ALL INFORMATION IS KEPT CONFIDENTIAL! Filling in this form is your contribution to enabling other unemployed people to continue to have our services available.

Thank you for completing this survey.

For questions, comments, or suggestions about this form, please e-mail

Member Information

Name:
CCL Membership#:
Street Address:
City, State Zip:

Employment Information

Company Name:
Company Address:
Company City, State - Zip:
Phone:
Job Title
Hire Date:
Wage: (please specify hourly or weekly)
Hours Per Week:

Benefits (Click all that apply):

Medical Insurance
Pension
Social Security
No Benefits

What source(s) led you to your current job?
(can be more than one)

Staff Assisted Referral from the Career Center of Lowell
Newspaper Advertisement
Networking Contacts (Friends/Acquaintances)
Career Center Resources
Placement Firm/Employment Agency
Other:

Have you received training funded by the Career Center of Lowell?
If yes, please specify the school and program:

School:
Program:

Enter the code as it is shown (required):

Career Center of Lowell |107 Merrimack St. |Lowell, MA. 01852 | 978-458-2503
© 2008 by Career Center of Lowell
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Job Seekers: