2902 Route 9
EMPLOYEE REFERRAL FORM
This form must be on file prior to initial interview and hiring to
qualify for an award.
Date: ________________________
I would like to refer:
Name: ___________________________ Address: ___________________________________
Phone: ___________________________ For the position of ___________________________
Job Title
Department: _______________________________________
I understand that if this recommendation results in hiring a regularly scheduled employee and if after six (6) months, both the person recommended and myself are employees of Saratoga ARC, in good standing, I will receive a referral award of $500.00.
___________________________________ ________________________________________
Signature of Staff Making
Recommendation Print
Staff Name
________________________________________
Program Worksite
Department Use Only
Do Not Write in space below
Date Date of Projected (6)
Received:
___________________ Hiring:
___________________ Month Date:
________________
Approved for payment Not Approved
Reason
Not Approved _________________________________________________________________
Signature:
__________________________________
Date: _________________________________
06/23/03