INSTRUCTIONS:
1. Referring employee completes Section I.
2. Job applicant completes Sections II and III.
3. Job applicant must write name of referring employee on employment application at time of completion.* Once the employment
application has been completed, signed, and dated, it may not be altered.
4. This submission form must be returned with employment application or within 30 days of start date to the recruitment office.
PLEASE PRINT
REFERRING EMPLOYEE NAME
LOCATION
SECTION
I
JOB TITLE
TELEPHONE NUMBER
WORK
(
SECTION
II
HOME
)
(
E-MAIL
)
SIGNATURE OF REFERRING EMPLOYEE
EMPLOYEE ID NUMBER
DATE
APPLYING FOR THE POSITION OF
LOCATION (FACILITY NAME/CITY)
JOB NUMBER
NAME OF APPLICANT
TELEPHONE NUMBER
SECTION
III
DATE
WORK
(
HOME
)
APPLICANT SIGNATURE
(
E-MAIL
)
THE FOLLOWING BOXES
ARE TO BE FILLED OUT BY
RECRUITMENT SERVICES
ONCE HIRED.
EMPLOYEE ID NUMBER
START DATE
FOR OFFICIAL USE ONLY
APPROVING ENTITY SIGNATURE (HIRING MANAGER)
SECTION
IV
AWARD AMOUNT
PRINT NAME
DATE
PHONE NUMBER
RECRUITMENT SERVICES SIGNATURE
ENTITY/LOCATION/COST CENTER/05250
PRINT NAME
Recruitment Services Initiative (please see ERP position eligibility list) ____________________________________________________.
(FACILITY NAME)
*EXCEPTION: My employment application is currently on file with Kaiser Permanente for a different position and reflects a different referrer name
than stated above. I certify that I was referred to the position reflected on this document by ________________________________.
WHAT IS ERP?
ERP is an acronym that stands for Employee Referral Program. This program gives Kaiser Permanente employees the
opportunity to earn cash awards when their referrals are hired into ERP-eligible positions.
WHO IS ELIGIBLE TO MAKE REFERRALS?
If you’re an active Kaiser Permanente Northern California employee, you’re eligible to participate in our Employee Referral
Program. To receive payment, you must be active on the payroll on the date of referral and on the date the award is distributed.
The only employees who are not eligible are the following:
• Employees of Human Resources (Human Resources staff, Recruitment/TPMG Physician Recruitment).
• Employees or physicians with supervisory responsibility to the referred candidate within area or scope of responsibility.
HOW TO MAKE A REFERRAL
Making a referral is easy. Just follow these four simple steps
• Ask your job applicant to complete the “Referral” section of their employment application with referring employee’s name.
• Complete Section I of the Submission Form and give it to your referral.
• Ask your referral to complete Sections II and III and submit the form with their employment application to the
Recruitment Office.
• Submission Form must be returned with employment application or within 30 days of start date.
HOW ARE THE AWARDS DISTRIBUTED?
After the new hire has completed 90 days of employment, the award payment will be issued as part of the referring employee’s
payroll check. Payment will be delivered in one lump sum indicated in the description section as Employee Referral. Because
the award is considered employee income, it is subject to tax per state and IRS guidelines.
WHAT ELSE DO I NEED TO KNOW ABOUT ERP?
• You may refer applicants for any number of ERP-eligible positions and will be eligible to receive multiple awards if
your referrals are subsequently hired for those openings.
• If either you or your referral terminates employment prior to scheduled payment, you will not be eligible for the award.
• ERP may be modified or discontinued at any time. Award payments in process at the time of such changes or
discontinuance will be honored.
• Prospective candidates referred to Kaiser Permanente through search firms or executive staffing agencies
(both contingent or retained) who are subsequently hired by Kaiser Permanente are ineligible to be referred.
• Previous employees who were contracted through a temporary agency, registry, or traveler who applied to an
ERP-eligible position within 12 months of leaving the company are ineligible to be referred.
• Former Kaiser Permanente employees who terminated employment within the last 12 months are ineligible to
be referred.
For complete ERP guidelines, please visit kp.org/jobs/erp.