Bills for Skills : Make a Referral

All fields are required except where marked as optional(♦)
Note: Existing account information will not be updated from this form.
Employee Information
Your First Name   Your Last Name  
Your Employee ID
(what is this?) 		    Confirm Employee ID   
Your Title ♦ Your Telephone   format: xxx-xxx-xxxx
Your Department ♦ Your Email   
Alternative Email ♦ 

Referral Information
Referral First Name  
Referral Last Name  
Referral Telephone    format: xxx-xxx-xxxx
Referral Email ♦ 
Bonus applies only to positions listed that result in regular hires (72 hours biweekly)
- relief and per diem excluded.
Referred Position  
Primary Job Number   View current Hot Job numbers here
Alternate Job Number ♦
Alternate Job Number ♦
Referral Notes  ♦
Resume
♦
♦ = denotes optional field