Submit Employee Referral

Employee Information

Red = Required Information

Referred By:
Employee Number:
Department:
Relationship to Candidate:
friend, family member, referred by 3 rd party, or other (please specify)

Candidate Information:

First Name:

Middle Name:

Last Name:

Primary Phone #:

Primary Phone Type:

Alternate Phone #:

Alternate Phone Type:

Email:

Requisitions:

[Add]

Why is this person a good fit for the position?

Why a good fit?:

Candidate Resume:
Supported formats: DOC, DOCX, RTF, PDF, TXT, HTML

Attach resume:

I have read and understand the Company’s Employee Referral Incentive Program. I understand that if the candidate I referred is hired as a result of my referral, I will receive a referral bonus minus deductions, via payroll deposit once the referred employee has been employed with the Company as specified in the Employee Referral Incentive Program. This form must be submitted prior to the referred candidate’s start date.

Employee Signature:

Date Signed: