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.