New Hire Reference

new hire reference request form

This reference request form should be filled out by a person who has personal knowledge about the applicants employment history, education, or character that can attest to the ability of the candidate to provide services to individuals with disabilities. References CANNOT be from FAMILY members.

Please complete the questions listed below keeping in mind that Home and Community based services (HCBS) may be performed unsupervised in the home of the person with developmental disabilities or in the residence/facility of the applicant. Your time and effort in completing this form is appreciated and strictly confidential in regards to your responses will be observed within the provisions of the law.

* Indicates required field

Applicants name *

Persons name providing reference *

Email *

Phone Number *

How long have you known the applicant? *

Indicate if you have any reason to believe that the applicant would not be suited to provide services to individuals with disabilities. *

Any additional comments which will help us in evaluating this applicant *

If other, please specify *

If the applicant was a former employee, would you rehire this person? *

Indicate your feelings on how you believe the applicant will relate to individuals with disabilities. Describe your knowledge of any characteristics the applicant may ave with working with disabilities. *

Persons signature providing reference (please type) *

Submit

New Hire reference
request

new hire reference request form

Tucson Location:
205 W. Giaconda Way
Suite 135
Tucson AZ 85704
(520)-329-8830
Fax (520) 612-7892

New Hire reference​request

new hire reference request form

Tucson Location:205 W. Giaconda WaySuite 135Tucson AZ 85704​(520)-329-8830Fax (520) 612-7892

New Hire reference
request

Tucson Location:
205 W. Giaconda Way
Suite 135
Tucson AZ 85704
(520)-329-8830
Fax (520) 612-7892