ProMatch Return to Work Form

Congratulations on your new job! Please provide ProMatch with your work information, as this information ensures that ProMatch will continue to receive government funding. If you later wish to rejoin ProMatch, please complete a "Request to Re-Activate" form and meet with staff to discuss reactivating your membership.

Please fill out, print, sign, and give the following form to ProMatch staff. You can also fax or mail your completed form - contact information is listed at the bottom of this page. You will not be able to email this web site form to staff, as the information that you enter in this form will not save.

Company/Employer Name:

Start Date:

If you are working through an agency, please list its name:

Work Address:

New Job Title:

Supervisor's Name (Note: We will not contact your supervisor for any reason..):

Wage/Salary (For statistical purposes only. Information is kept confidential.):

Will you be receiving benefits? :
Yes No

Will you be covered by Unemployment Insurance :
Yes No

Industry (New):

How does your new position compare with your previous position?
Responsibility:
Much Higher Higher Same Lower Much Lower
Salary:
Much Higher Higher Same Lower Much Lower

How did you get the lead for this job?
Networking Newspaper Friend/Acquaintance Job Fair
Previous Employer Recruiter Hit From ProMatch Profile Internet
Other (Specify):

What do you suggest ProMatch should add or do better?

What advice would you offer to new members?

REMEMBER: Please print this form before leaving this page or closing the browser window, otherwise you will lose any information you entered.

Your Signature _______________________ Today's Date:

ProMatch staff signature:__________________Date:_______________________

Thank you, and congratulations on your new job!