ACCEPTABLE REFERENCES FORM

To Be Completed By Candidate

All Candidates Considering Employment With Sunnybrook Must Complete This Form.

ACCEPTABLE REFERENCES

For Regular Staff For New Graduate
Current Employer Current Placement
Reference #1
Manager or Supervisor Preceptor or Instructor
Most Recent Employer Other Recent Placement
Reference #2
Manager or Supervisor Preceptor or Instructor
Recent Employer Recent Employer
Reference #3
Manager or Supervisor Manager or Supervisor

 UNACCEPTABLE REFERENCES 
For Regular Staff For New Graduate
Example #1 Friend or Colleague Friend or Colleague
Staff Nurse or Charge Nurse or
Anyone who is/was not in a formal
Example @2 Family Member
position or capacity to have
evaluated your performance.
Anyone who is/was not in a formal
Example #3 Family Member position or capacity to have
evaluated your performance.
Preceptor or Instructor While a
Example #5
Nursing Student

TERMS AND CONDITIONS
TO ACCEPT

I understand that all forms must be printed clearly using black ink.
1.  YES
These forms are faxed so they must be legible.
I hereby declare that I read and understood the reference guidelines
2. noted above and will complete the Reference Check Consent Form A  YES
appropriately.
I understand that Sunnybrook uses a company called BackCheck to check
3. my references. I will contact my references as soon as possible to advise  YES
them that they may get a phone call or e-mail from BackCheck.
I understand that my current manager/supervisor will only be contacted
4. for a reference if I become the preferred candidate for the position for  YES
which I am being considered.

Signed:
Signed: ____________________________________ Dated: ______________________