Reference Check Consent Form

CARING SHERPHERDS HEALTHCARE INC
I hereby authorize Caring Shepherds Healthcare Inc to contact the following references to verify my employment history and assess my suitability for the position of Home Care Aide I understand that Caring Shepherds Healthcare Inc may ask my references questions about my employment history skills performance and other relevant information I also agree to release all references from any liability arising from the provision of truthful information*
Signature of applicant*

Clear
Date*

MonthDayYear
Date
Supervisor Signature

Clear
Date

MonthDayYear
Date
Should be Empty: