Professional Reference Form (Non-employer)

BAYADA Home Health Care needs your help in order to hire people who will provide compassionate, reliable and excellent care to our clients. We specialize in providing home health care to people in their own homes and employ a staff of experienced RNs, LPNs, Home Health Aides, Companions and Therapists.

In order to maintain our high standards, BAYADA is committed to a very thorough screening process which includes work history investigation. Please take a few minutes to complete the questionnaire below. All information received will be kept strictly confidential.

All fields marked with * are required.

  1. How long have you known the prospect?
  2. How do you know the prospect (nature of relationship):

  3. Based on your knowledge of the prospect, please answer the following questions. Additional comments and information that will help our evaluation are appreciated.
    • Reliability: Is the prospect dependable and one who keeps commitments to others? Yes No

    • Compassion: Does the prospect demonstrate a caring attitude and understanding of others? Yes No

    • Excellence: Does the prospect possess abilities and judgment you would want in a caregiver? Yes No

  4. Would you recommend? Yes

I understand that entering my name in this box constitutes a legal signature.