EOANF-HRD

Exact Title of The Position Applied For:(Required)

Applicant’s Name(Required)

First Middle Initial Last

Social Security # (last 4 only)(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Check boxes as applicable.(Required)

I wish to be considered as a veteran applicant under General Laws Chapter 31, Section 26, for provisional appointment to the above position.

I wish to be notified of the date of the examination for this position if one is to be held within a year of this date.

I am a veteran

False information provided in this application could lead to removal from a civil service position. I hereby declare that the statements and answers on this application are true and are made under the penalties of perjury.

Name(Required)

By typing my name, I confirm that the information provided is true and accurate, and I agree to the terms stated above.

Full Name:

Date of Application:(Required)

For more information please email: civilservice@mass.gov.