Health Care Services
1-800-260-6145
Franchise
1-800-953-6183
info@signalhg.com
info@signalhg.com
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Reference Consent and Results
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Reference Consent and Results
Reference Consent and Results
Print Employee Name:
Employee Signature:
Company Contacted:
Mr./Mrs.
is seeking employment with our company. It is our policy to ask for references prior to employment. Please complete this form for our records and sign below. We would greatly appreciate your assistance.
PLEASE VERIFY EMPLOYMENT DATES:
From:
To:
ELIGIBLE FOR REHIRE?
YES
NO
COMMENTS:
Information received by:
Phone
Mail
Fax
Signature of Agency
Representative
Date