Who may submit a referral form?

Typically a hiring manager, staffing coordinator, or authorized HR representative submits the referral; some organizations allow delegated approvers with documented authority to act.

Is an electronic signature valid?

Yes. Electronic signatures are enforceable under ESIGN and state e-signature laws when intent, consent, attribution, and reliable retention are present.

When is notarization required?

Most referrals do not require notarization; if a host site or specific state rule asks for notarization, follow that jurisdiction’s requirements and retain the notarized copy.

What if the employee name differs from ID?

Resolve discrepancies before assignment by confirming legal name and updating records; mismatches can delay background checks, payroll, and site access.

How are attachments handled electronically?

Attach PDFs or DOCX files to the referral, label each clearly, and verify legibility; ensure attachments are stored with the signed referral in the HR record.

Can a referral be revised after approval?

Yes. Create an addendum or versioned referral that records the change, the approver, and the effective date to maintain an auditable history.

Electronic Signature
Templates
HR
Employee Worksite Referral

Employee Worksite Referral

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYEE WORKSITE REFERRAL

This Employee Worksite Referral documents the referral and proposed placement of an employee to a host worksite for temporary assignment, special project, or permanent placement. Completion of this form initiates administrative review, confirmation of site requirements, and authorization for the referred placement. The referring Employer retains responsibility for payroll, benefits and statutory obligations except as otherwise specified in writing below.

Personal Information

Full Legal Name Employee ID (if applicable) Home Address

Phone:

Email:

Position Information (Current)

Current Job Title Department

Reporting Manager:

Current Hire Date:

Current Compensation

Proposed Worksite Assignment

Host Worksite Name Worksite Address

Worksite Contact:

Contact Title:

Contact Phone:

Contact Email:

Proposed Position at Worksite Primary Duties / Scope of Work

Proposed Start Date:

Estimated End Date (if any):

Work Schedule / Hours

Safety, Training and Site Requirements

Indicate site-specific requirements. The referring Employer will ensure the employee completes all mandatory site training and certifications prior to placement or on the first assigned day as agreed with the Host Worksite.

Site Requirements (check all that apply) Safety orientation required Site-specific training required Personal protective equipment required Background check required Drug/alcohol testing required

Additional Safety / Training Notes

Compensation and Administrative Responsibility

Indicate the payroll and administrative arrangements. Absent a separate written agreement, the referring Employer remains responsible for wages, taxes, benefits, workers' compensation and insurance for the referred employee.

Paying Entity (check all that apply) Referring Employer Host Worksite Third-party (describe below) If third-party or special arrangement, describe

Employment History

Provide two most recent employers. Attach additional documentation if necessary.

Most Recent Employer - Company Name Title / Role

Dates Employed:

Reason for Leaving:

Primary Responsibilities Previous Employer - Company Name Title / Role

Dates Employed:

Reason for Leaving:

Primary Responsibilities

Education

Highest Degree / Certification Institution Graduation Date

Professional References

Provide three professional references who can verify qualifications and work history.

Reference 1 - Name

Reference 2 - Name

Reference 3 - Name

Legal Disclosures and Authorizations

At-Will Employment: Where applicable, the referring Employer and the referred employee acknowledge that employment remains at-will, subject to the laws of the jurisdiction in which the employee performs services, unless otherwise memorialized in a separate written agreement signed by an authorized representative of the Employer.

Equal Opportunity: The Employer and Host Worksite affirm compliance with applicable equal employment opportunity laws. Decisions regarding placement and assignment shall not be based upon protected characteristics.

Authorization to Verify: The employee authorizes the Employer and Host Worksite to verify employment history, references, professional credentials, and to obtain background checks and drug testing if required by site policy. Information obtained will be used for placement decisions and retained in accordance with employer recordkeeping requirements.

Employee Acknowledgement (typed name constitutes consent)

Printed Name:

Signature (typed):

Date:

Applicant Certification

I certify that all information provided on this Employee Worksite Referral is true, complete and correct to the best of my knowledge. I understand that any material misstatement, omission, or falsification may result in withdrawal of the referral or removal from placement. I authorize the release of information necessary to verify credentials, employment history and fitness for assignment.

Additional Remarks

Administrative Use Only

HR Review Notes

Referring Employer Representative:

By:

Date:

Host Worksite Representative:

By:

Date:

What an Employee Worksite Referral Is and When it’s Used

An Employee Worksite Referral is a written record that documents the placement or reassignment of an employee to a specific worksite, client location, or project site. The form captures essential details such as the employee’s identity, proposed worksite address, assignment dates, role or duties, supervising contact, and any special safety or credentialing requirements. Organizations use it to authorize access, trigger onboarding or credential checks, coordinate payroll and tax treatment, and maintain an auditable trail for compliance, dispute resolution, and workforce management.

Why a Formal Referral Record Matters

A concise referral form reduces administrative ambiguity and creates a dated record of who approved the assignment and under what terms.

Who Typically Completes and Signs This Form

Several roles interact with an Employee Worksite Referral depending on the organization and assignment type.

HR administrators — prepare the referral, verify documentation, and coordinate payroll or benefits changes.
Hiring managers or supervisors — confirm job duties, start date, and on-site supervision arrangements.
Client site contacts — accept the employee onto the worksite and confirm site-specific requirements or clearances.

Final signatories often include the employee and an authorized approver to confirm consent and acceptance of site terms.

Essential Sections to Include on the Referral

A professional referral groups identification, assignment details, approvals, and attachments so reviewers can act quickly and accurately.

Employee Details

Full legal name, contact information, employee ID, and tax classification to match payroll and background checks.

Worksite Information

Exact address, host organization, on-site supervisor name and contact, site entry instructions, and security or parking notes.

Assignment Terms

Start and end dates, expected hours, primary duties, shift patterns, and any temporary status or remote work allowances.

Authorization & Approvals

Signatures and printed names for the submitting manager, HR reviewer, and host site approver with dated consent fields.

Compliance Checks

Credential verification, training requirements, background checks, drug testing status, and required certifications listed explicitly.

Attachments

Supporting items such as proof of certification, I-9 documents, site waivers, safety orientation acknowledgements, and insurance evidence.

Quick Step-by-Step: Completing a Worksite Referral

Follow these steps in order to prepare, approve, and distribute the referral efficiently.

01

Gather Information: Collect IDs, certifications, and site instructions before starting the form.
02

Complete the Form: Enter fields accurately and attach required documents in the specified formats.
03

Routing for Approval: Send to HR, the hiring manager, and the host-site approver in defined order.
04

Store the Record: Save signed copies to the employee file and the centralized record system for retention.

Recommended Digital Workflow Settings

Configure routing, authentication, and retention so referrals move automatically and remain auditable.

Workflow Field	Recommended Setting
Signer Authentication	Email plus SMS code for routine; stronger ID for sensitive sites
Routing Order	Submitter → HR reviewer → Hiring manager → Host-site approver
Notifications	Enable automated reminders at 48 and 72 hours before needed approvals
File Retention	Archive signed PDF to HR record with retention metadata

How Electronic Submission and Routing Typically Works

A standard e-submission flow minimizes manual handoffs and preserves an audit trail.

Upload Document: Sender uploads completed form and attachments.
Place Fields: Add signature, date, and required checkbox fields.
Send to Signers: System emails signers in the configured sequence.
Capture Audit Trail: Platform records timestamps, IP addresses, and actions.

Technical Considerations for Digital Use

Confirm format, integrations, and authentication options before digitizing referrals.

File Formats: Use PDF or DOCX for compatibility and preservation.
Integrations: Connect to HRIS, payroll, or CRM systems to reduce duplicate entry.
Authentication Options: Enable email, SMS, or stronger methods for high-risk assignments.

Ensure the chosen platform supports audit trails, secure storage, and the export formats required by your records policy.

Key Deadlines and Timing to Track

Time-sensitive items on a referral affect payroll, eligibility, and regulatory compliance.

Submit Before Start:

Provide referral at least five business days before the assignment when possible.

I-9 Verification:

Complete Section 2 within three business days of the employee’s first day.

Payroll Cutoff:

Meet payroll deadlines so pay and withholding match assignment dates.

Credential Expirations:

Verify certifications are current on or before the start date.

Change Notices:

Update the referral within 24–48 hours of any assignment change.

Milestone Timeline for a Typical Referral

Sequential milestones help teams coordinate approvals, onboarding, and site readiness.

01

Request Submission

Manager or staffing coordinator prepares and submits the referral.

02

HR Review

HR verifies employment, benefits impacts, and required screenings.

03

Host-Site Approval

Client or site confirms access, orientation, and insurance requirements.

04

Assignment Start

Employee begins work and HR finalizes payroll and records.

Security and Compliance Features to Expect

Encryption in Transit: TLS 1.2/1.3

Encryption at Rest: AES-256

Audit Trail: Timestamped action log

Regulatory Standards: ESIGN and UETA compatible

HIPAA Support: BAA available

Certifications: SOC 2 Type II, ISO 27001

Potential Penalties and Operational Risks

Data Breach Fines: State and federal penalties

I-9 Paperwork Fines: $281–$2,789 per violation

Payroll Errors: Underpayment and back pay exposure

Tax Withholding: Backup withholding risks

Site Liability: Injury or compliance claims

Contract Disputes: Misstated duties or dates

Common Mistakes to Avoid

Missing or inconsistent employee names that prevent background check and payroll matching.
Incorrect worksite address or supervisor contact that delays access and orientation processes.
Omitting required credential proofs such as certifications, licenses, or site-specific training records.
Failing to capture dated approvals and signatures, creating disputes about who authorized the assignment.

Comparing eSignature Options for Referral Workflows

Key pricing and capability differences affect per-user costs and high-volume workflows; signNow is listed first for direct comparison.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Yes, trial available	Yes, trial available	Yes, trial available	Yes, trial available
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year limit	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions About Employee Worksite Referrals

Answers to common questions about completion, signatures, and storage to help prevent delays or compliance issues.

Need help? Contact support

Who may submit a referral form?
Typically a hiring manager, staffing coordinator, or authorized HR representative submits the referral; some organizations allow delegated approvers with documented authority to act.
Is an electronic signature valid?
Yes. Electronic signatures are enforceable under ESIGN and state e-signature laws when intent, consent, attribution, and reliable retention are present.
When is notarization required?
Most referrals do not require notarization; if a host site or specific state rule asks for notarization, follow that jurisdiction’s requirements and retain the notarized copy.
What if the employee name differs from ID?
Resolve discrepancies before assignment by confirming legal name and updating records; mismatches can delay background checks, payroll, and site access.
How are attachments handled electronically?
Attach PDFs or DOCX files to the referral, label each clearly, and verify legibility; ensure attachments are stored with the signed referral in the HR record.
Can a referral be revised after approval?
Yes. Create an addendum or versioned referral that records the change, the approver, and the effective date to maintain an auditable history.

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