Your name*

Your email*

Name of Candidate Referring*

Candidate contact information (email or phone)*

Type of position they are interested in:* Registered NurseLicensed Practical NurseCertified Nursing AssistantRehab Services (Physical Therapy, Occupational Therapy, Speech Therapy)Administrative/officeOther:
Relationship to candidate (family, friend, other):*

By signing below, I understand that the following conditions apply to this program:

• This Candidate Referral Form MUST be submitted to Human Resources prior to interview or contact with candidate to be eligible for the Referral Bonus Award.

• The Referral Bonus Program does not guarantee the applicant will be hired.

• Referred applicants must be new hires.

• Hire of an applicant is subject to the usual and customary employment criteria of RVNAhealth, including but not limited to background/ reference checks and pre-employment screening.

• I must be employed by RVNAhealth and in good standing when the bonus award is due in order to receive payment.

• Referred employee must successfully complete their probationary period and be in good standing per the RVNAhealth Referral Bonus Award Policy

Employee Electronic Signature (type name):*

Date:*