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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.