Veterans and Eligible Spouses Triage

The MassHire Department of Career Services provides employment and training services to veterans and their families. Dedicated staff are available throughout the State to help Veterans transition to civilian employment. Veterans and their eligible spouses receive Priority of Service throughout the full array of services provided through the MassHire Career Center system.

Full Name

Today’s Date

Date

Address

Street Address Line 2

City/Town

Email

example@example.com

Phone

This form is used to determine your eligibility for additional services and is intended solely to provide priority to Eligible Veterans and Eligible Spouses or Persons that meet certain criteria. This information is being requested on a voluntary basis and will be kept confidential. Refusal to provide the information will not subject you to any adverse consequences.

I served in the U.S. Armed Forces and was on active duty for more than 180 days other than for training*

Date of Service: From

Date

To

I was discharged or released under conditions other than Dishonorable?*

I have a service connected disability or have a pending V.A claim for a service connected disability.*

I am a member of the US Armed Forces who is wounded, ill, or injured and receiving treatment in Military Treatment Facilities (MTFs) or Warrior Transition Units (WTUs)

I am a homeless or at risk of homelessness (Notified of impending eviction, lack of fixed regular adequate residency, or sharing housing due to loss of housing hardship)*

I am a recently discharged transitioning member of the U.S. Armed Forces.*

I am a previously incarcerated veteran.*

I am a Veteran lacking a high school diploma or equivalent certificate.*

I am considered low-income and/or receiving public assistance Chapter 115 Benefits, SNAP, Etc*

I have been unemployed for more than 26 weeks

I am a Veteran between the ages of 18 and 24 years' old.*

I am a Vietnam Veteran or Vietnam-era Veterans For which any part of their active military, naval, or air service was during the Vietnam era the period beginning February 28, 1961, and ending May 7, 1975, in the case of a veteran who served in the Republic of Vietnam during that period, and the period beginning August 5, 1964, and ending May 7, 1975*

I am the Spouse of a Veteran AND meet one of the following criteria: - Spouse of an active duty member who is currently listed as either Missing in Action (MIA), or as a prisoner of war, captured or detained/interned, for more than 90 days. - Spouse of a 100% service-connected disabled Veteran as determined by the VA - Spouse of a Veteran who had a 100% service-connected disability rating at the time of death - Spouse of a Veteran who died of a service-connected disability*

How did you hear out about the MassHire South Shore Career Center? (please specify below)

May we contact you?*

Thank you for your service to our country The MHSSCC Veteran Employment Representative Team looks forward to assisting you

MassHire Program and Services are funded in part by US Department of Labor (USDOL) Employment and Training Administration grants as well as non-federal funded grants. Additional details furnished upon request