Odh Form 805 - Uniform Employment Application For Nurse Aide Staff (Page 7 of 7) in pdf

Odh Form 805 - Uniform Employment Application For Nurse Aide Staff Page 7

SAINT SIMEON'S EPISCOPAL HOME

3701 North Cincinnati

Tulsa, OK 74106

REFERENCE CHECK CONSENT FORM

We want you to know that reference checking is an important part of our hiring process.

In addition to contacting the persons you furnished us as references, we may also contact

other business associates, acquaintances and friends. We ask all references a series of

questions about work experience, character, personal habits, educational background and

personality. In some cases, we ask an outside firm to check references.

I , _________________________________________________________, voluntarily

consent to allow Saint Simeon's Episcopal Home or any of its officers, employees or

agents to check my references by contacting any person whom they deem to be an

appropriate reference. I understand that these questions may be about my personal or

educational background, work experience, character and personality.

______________________________________________ ____________________

Applicants Signature

Date

Odh Form 805 - Uniform Employment Application For Nurse Aide Staff Page 7