Reference Check Authorization Form

Reference Check Authorization Form

Authorize the organization to contact your references to verify your background and work history.
I, First Name Last Name , authorize 1st Choice Home Health Care Services Ltd. to contact my references and obtain any relevant employment-related information.

By signing this form, I consent to 1st Choice Home Health Care Services Ltd. contacting my references before and/or during my employment with the organization.

I understand that the purpose of the reference check is to ensure that I am a suitable fit for 1st Choice Home Health Care Services Ltd., and that the organization is a suitable fit for me as well. Reference checks help the organization gain a broader understanding of my skills, work ethic, professional conduct, and the impact I have had on previous colleagues, employers, and clients.

I acknowledge that the information obtained through the reference check process may be used as part of the employment evaluation process.
Full Name

First NameLast Name
Date

MonthDayYear
Date
By signing below, you consent for 1st Choice Home Health Care Services Ltd. to contact your references before and/or during your employment with the organization. You authorize the release of any information given by your references.
Please write your full name if you agree to sign this agreement.
Reference Information

Please provide complete information for your references.
Reference 1
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Since when have you known this person?

MonthDayYear
Date
Reference Type:
How do you know this person?
Reference 2
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Since when have you known this person?

MonthDayYear
Date
Reference Type:
How do you know this person?
Should be Empty:

Reference Check Authorization Form

Reference Information

Reference 1

Reference 2