Employee Referral Form
Referring Employee Name
First Name
Last Name
Referring Employee Position
Employee Email Address
*
example@example.com
Candidate Information
Candidate Name
First Name
Last Name
Candidate Email Address
example@example.com
Candidate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Candidate's Desired Position (Patient Care Specialist, Pharmacy Technician, Driver, Pharmacist)
How do you know the candidate?
Former coworker
Friend/Family member
Professional acquaintance
Other
If other, please explain.
Candidate Qualifications
How long have you known the candidate?
Less than 6 months
6 months - 1 year
More than 1 year
Why do you believe this candidate would be a good fit for Chancy Drugs?
What skills, experience, or qualities make this candidate a strong fit for the role?
Have you worked with this candidate in a professional setting before?
Yes
No
If yes, please describe your experience.
How did you come across this candidate?
Candidate reached out to me
I saw the candidate’s resume or profile online
I met the candidate at an event
Other
If other, please explain.
Any additional comments or insights?
By submitting this referral, I confirm that the information provided is accurate to the best of my knowledge.
If the employee is hired, the referral bonus will be paid after 90 days of the candidate's employment. Candidate must remain in good standing with company standards of conduct within that time to qualify.
Submit
Should be Empty: