Skip to main content
search
Menu
ABOUT
–
OUR LEADERSHIP
OUR STORY
JOIN OUR TEAM
E-NEWSLETTER
–
PHOTO GALLERY
ANNUAL REPORT
LOCATIONS
CONTACT US
PROGRAMS
–
REFER A CLIENT
DIABETES SERVICES
DIABETES DAYTON
CANCER SERVICES
MEALS-ON-WHEELS
SENIOR FARMERS MARKET
WELLNESS SERVICES
–
CARRIE’S CAFE & SENIOR DINING CENTERS
HELP-AT-HOME
PERSONAL EMPOWERMENT SERVICES
HIV/AIDS NUTRITIONAL SUPPORT
SENIOR PET CARE
VISITING NURSES
SUPPORT
–
DONATE
PLANNED GIVING
LEGACY ENDOWMENT CAMPAIGN
ENDOWMENT RESOURCE DIRECTORY
LIFECARE ALLIANCE STORE
–
SHOPPING REWARDS
Cancer Thrift Shops
SOCIAL ENTERPRISE
VOLUNTEER
VOLUNTEER APPLICATION
Blog
Referrals
search
Volunteer
Give Now
ABOUT
–
OUR LEADERSHIP
OUR STORY
JOIN OUR TEAM
E-NEWSLETTER
–
PHOTO GALLERY
ANNUAL REPORT
LOCATIONS
CONTACT US
PROGRAMS
–
REFER A CLIENT
DIABETES SERVICES
DIABETES DAYTON
CANCER SERVICES
MEALS-ON-WHEELS
SENIOR FARMERS MARKET
WELLNESS SERVICES
–
CARRIE’S CAFE & SENIOR DINING CENTERS
HELP-AT-HOME
PERSONAL EMPOWERMENT SERVICES
HIV/AIDS NUTRITIONAL SUPPORT
SENIOR PET CARE
VISITING NURSES
SUPPORT
–
DONATE
PLANNED GIVING
LEGACY ENDOWMENT CAMPAIGN
ENDOWMENT RESOURCE DIRECTORY
LIFECARE ALLIANCE STORE
–
SHOPPING REWARDS
Cancer Thrift Shops
SOCIAL ENTERPRISE
VOLUNTEER
VOLUNTEER APPLICATION
Blog
Referrals
Volunteer
Give Now
Press enter to begin your search
Close Search
Careers
Current/Former Employer Reference Form
Step
1
of
3
33%
Applicant Name
First
Last
Name of Person Providing Reference
First
Last
Title of Person Providing Reference
Name of Company for Which Applicant Works/Worked
Position Applicant Holds/Held
Date Employment Began
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Date Employment Ended
(If currently employed, leave this field blank.)
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Reason for Leaving
Please describe the type of work for which the applicant is/was responsible.
How would you describe the applicant's relationships with coworkers and subordinates (if applicable)?
Describe the applicant's attendance record and punctuality.
How would you describe the quantity and quality of output generated by the employee?
Does the applicant work well independently? As a member of a team?
What was the biggest project your are aware of that the applicant worked on for your organization?
What are the applicant's strengths?
In what areas can the applicant continue to develop?
Would you recommend the applicant for this position? Why or why not?
Are you aware of anything that would prevent the applicant from performing the duties of this job?
Would the applicant be eligible for rehire by your company?
Other Comments
Volunteer
Volunteer Application
Adopt-a-Route
Contact the Volunteer Team