Policy Manual sample

MDT Home Health Care Agency, Inc. REFERENCE FOR POTENTIAL EMPLOYEE Name of Applicant: Address of Applicant: List three (3) persons we may contact for professional references: Name Address Telephone 1. 2. 3. Date of phone contact: Past employment confirmed: Yes No Would reference re-hire? Yes No Name of phone contact: Name of staff making this call: Date and time of this call: Home Health Agency. - - Personnel/Operations Policies B-28