Revised April 2019

IDOC EMPLOYEE REFERRAL FORM

Referring Employee Section:

Name: _________________________ Facility: ______________________

Job Title: _______________________ Referral Date: __________________

PeopleSoft Number: _____________________

I have read and understand the IDOC Employee Referral Program Policy.

_____________________________________ Referring Employee’s Signature

Applicant’s Name: ____________________ Position Referred to: ____________________

*Referring Employee must forward form to Human Resources.

HR USE ONLY:

Applicant’s Hire Date: ___________________ Applicant’s Job Title: ___________________

Applicant’s Facility: _____________________

HR Approver Name: _____________________ Approval Date: ________________________

*HR must forward completed form to Payroll for the processing of a $250.00 Agency Bonus to

Referring Employee.