Employment Referral Information Form

i.e. xxx-xxx-xxxx
Preferred method of contact:


Opportunity for advancement:

(Helps determine transportation needs for employee)
Probable Word Schedule:

(Please check all that apply)

(How many pounds required to lift, how often, etc.)
(bilingual, customer service experience, landscaping experience, etc.)
(must travel, no theft convictions, etc.)

Completing this form does not bind employer to receive any/all employee referrals from MCC 180 RAP.