Labor Service Application Form/Revised 6-20-2018
APPLICATION FOR LABOR SERVICE
CITY OF WORCESTER
Human Resources Department
455 Main Street, Room 109, Worcester MA 01608
Applicants must be at least 16 years of age at the time of filing application. TYPE or PRINT all answers on both sides
of this form in INK, and file it by mail or in person at the above address. Incomplete or unsigned applications will be
returned. The applicant will remain on the Labor Service register for the job titles for which he/she is registered for a
period of 5 years from the date of registration, subject to a renewal of registration as provided in Section 28, Chapter 31
of the General Laws, and subject to compliance with other applicable provisions of the civil service law and rules. The
labor service position titles including entrance requirements, if any, for which applicants may apply on this form, are
listed on the reverse side, together with instructions for indicating position selections.
1. Name ______________________________________________ 2. Social Security # XXX - ____ - _________
3. Address ____________________________________________________________________________________
Street City/Town State Zip Code
4. Mailing Address
(if different)____________________________________________________________________________________
Street City/Town State Zip Code
5. Phone #: _______________________________________ 6. Email: ____________________________________
7. Have you completed a course in a building, mechanical, maintenance or repair trade in a recognized trade,
vocational or technical school or a recognized training program? If answer is “yes,” complete the following:
Name of School or Program Title of Course Date of Course (Month/Date/Year)
______________________________________________________________From:__________To:___________
______________________________________________________________From:__________To:___________
8. Have you ever served in the United States’ armed forces during wartime as defined by Clause 43, Section 7 of
Chapter 4 and Section 1 of Chapter 31 of the Massachusetts General Laws? [ ] Yes [ ] No;
If you are claiming veteran’s preference, you must attach a copy of your DD-214 Form.
9. Are you the widowed unremarried spouse or parent of a veteran who died from a service-connected disability
incurred in wartime service? [ ] Yes [ ] No
10. Employment History: List the complete names and addresses of your employers and the type of work performed
for each during the past 10 years (you may attach a copy of your resume).
Employer Name Address Type of Work Dates Worked
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
11. Response to the following is voluntary. Failure to provide the information requested will not adversely affect
your application. (Check one of each statement.)
I am: ( ) Male ( ) Female
I am: ( ) White ( ) Black ( ) Hispanic ( ) Asian ( ) American Indian or Alaskan Native ( ) Other
Work Options: [ ] Permanent [ ] Temporary [ ] Part-time [ ] Intermittent [ ] Full-time
