315-638-2521
Directions
Referring
Physicians
Toggle navigation
Our Services
Short-Term Rehab
Independent Living
Assisted Living
Skilled Nursing
About
Our History
Our Continuum
Careers / Volunteer
Careers
Volunteer
Donate
Donate Now
Ways of Giving
Meet Our Donors
News & Resources
Blog
Events
Our Magazine
Helpful Links
Photo Gallery
Contact
Search
X
Former Employer Reference Release
Please complete the following:
Former Employee Name*
Former Employee Position(s)*
Dates Employed*
RATINGS
Quality of Work*
Excellent
Good
Fair
Poor
Productivity*
Excellent
Good
Fair
Poor
Cooperation*
Excellent
Good
Fair
Poor
Ability to Get Along with Others*
Excellent
Good
Fair
Poor
Attendance*
Excellent
Good
Fair
Poor
Reason(s) for Termination of Employment:*
Would you re-hire this employee?*
Yes
No
If no, why?
Additional Comments:
Signature*
Reset
What is your title?*
Submit
Please ensure Javascript is enabled for purposes of
website accessibility