Register for Services - MassHire Berkshire Career Center

Do you need special accommodations: (Required)

Name (Required)

First

Last

Phone (Required)

Email (Required)

Limiting English Speaking? (Required)

Number of Dependents under 18

US Citizen: (Required)

Disability (Required)

Other Barriers

Public Assistance (Required)

Please indicate any Public Assistance below (Required)

Are you registered for Selective Service (Required)

If no, explain?

High School Graduate GED/HiSET (Required)

College Graduate (Required)

Highest Grade of Education Completed (Required)

In School Currently? (Required)

What was the last school attended?

Most Recent Employer

Employer's Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title at Most Recent Employer

Start Date

Release Date

Salary

Hours Per Week

Please Check Off(✓) Any Services/Workshops You May Be Interested In (Required)

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