Employee Referral Submission Form
Complete the form and submit it to Human Resources before the referred candidate is interviewed to qualify for consideration.
Referring Employee Information
Employee Full Name
*
First Name
Last Name
Work Location
*
Please Select
Johns Creek (JC)
Hamilton Mill (HM)
Alpharetta (ALP)
Job Title
*
Date of Referral Submission
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Status
*
Regular Full-Time Employee
Manager (Not Eligible)
Other (Not Eligible)
Do you currently work at least 20 hours per week?
*
Yes
No
Referred Candidate Information
Candidate Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Position Applied For
*
Preferred Work Location
*
Please Select
Johns Creek (JC)
Hamilton Mill (HM)
Alpharetta (ALP)
Any Location
Date Referred
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Has the candidate already been interviewed?
*
Yes
No
Employee Acknowledgment
Policy Statements
Acknowledgment
*
I have read and understand the Employee Referral Program requirements and confirm the information submitted is accurate.
Referring Employee Signature
*
Signature Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Human Resources Use Only
Date Form Received
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Referral Submitted Before Interview
Yes
No
Duplicate Referral Check Completed
Yes
No
Candidate Interview Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Candidate Hire Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Candidate Work Schedule Meets 20-Hour Requirement
Yes
No
30-Day Employment Requirement Met
Yes
No
Referring Employee Meets Eligibility Requirements
Yes
No
Referral Bonus Approved
Yes
No
Bonus Amount (Fixed: $100.00)
Payroll Pay Period
HR Notes
HR Representative Name
Approval Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Referral
Submit Referral
Should be Empty: