{"id":51351,"date":"2023-09-28T13:28:37","date_gmt":"2023-09-28T17:28:37","guid":{"rendered":"https:\/\/health.uconn.edu\/human-resources\/?page_id=51351"},"modified":"2023-10-27T10:33:47","modified_gmt":"2023-10-27T14:33:47","slug":"uconn-health-employee-reference-form","status":"publish","type":"page","link":"https:\/\/health.uconn.edu\/human-resources\/services\/information-management\/uconn-health-employee-reference-form\/","title":{"rendered":"UConn Health Employee Reference Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_32' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_32'  action='\/human-resources\/wp-json\/wp\/v2\/pages\/51351' data-formid='32' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_32' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_32_25\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_25'><span class='gform-field-label__text'>Email<\/span><\/label><div class='ginput_container'><input name='input_25' id='input_32_25' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_32_25'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_32_1\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_1'><span class='gform-field-label__text'>Applicant Name:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_32_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_32_2\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_2'><span class='gform-field-label__text'>Position Title:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_32_2' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_32_3\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_3'><span class='gform-field-label__text'>Reference Provider Name\/Title:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_32_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   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class='gform-field-label__text'>Company Representing &amp; Contact Info:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_32_4' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_32_5\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_5'><span class='gform-field-label__text'>Applicant&#039;s Dates of Employment:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_32_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_32_12\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Please verify the following information:<\/h3><\/div><div id=\"field_32_10\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_10'><span class='gform-field-label__text'>Position Applicant Held:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_32_10' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_32_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Relationship to Applicant:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_32_11'><div class='gchoice gchoice_32_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Supervisor\/Manager\/Direct Report'  id='choice_32_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_32_11_1' id='label_32_11_1' class='gform-field-label gform-field-label--type-inline'>Supervisor\/Manager\/Direct Report<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_32_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Team Lead\/Charge Nurse'  id='choice_32_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_32_11_2' id='label_32_11_2' class='gform-field-label gform-field-label--type-inline'>Team Lead\/Charge Nurse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_32_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Co-Worker'  id='choice_32_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_32_11_3' id='label_32_11_3' class='gform-field-label gform-field-label--type-inline'>Co-Worker<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_32_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Educational'  id='choice_32_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_32_11_4' id='label_32_11_4' class='gform-field-label gform-field-label--type-inline'>Educational<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_32_11_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.5' type='checkbox'  value='None of the Above'  id='choice_32_11_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_32_11_5' id='label_32_11_5' class='gform-field-label gform-field-label--type-inline'>None of the Above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_32_13\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_13'><span class='gform-field-label__text'>Please describe your relationship:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_32_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_32_14\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Please answer the below questions:<\/h3><\/div><div id=\"field_32_15\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_15'><span class='gform-field-label__text'>How long have you known the applicant?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_32_15' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_32_16\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_16'><span class='gform-field-label__text'>How does the applicant interact with peers and management?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_16' id='input_32_16' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_32_17\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_17'><span class='gform-field-label__text'>Has the applicant received satisfactory performance evaluations? 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Please comment on skills and abilities.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_18' id='input_32_18' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_32_19\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_19'><span class='gform-field-label__text'>What feedback would you provide this applicant in order for them to achieve optimum work performance?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_32_19' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_32_20\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_32_20'><span class='gform-field-label__text'>Please describe the applicant\u2019s work ethic in regards to attendance and reliability.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_20' id='input_32_20' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_32_21\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>If given the opportunity, would you rehire this applicant?<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' 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