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Professional Reference & Verification

  • As part of our standard documentation and verification process, we are requesting the following information. PLEASE NOTE: By providing this information, you are granting Galileo Search, LLC permission to contact each individual listed to conduct professional reference verification and permission to verify your education, licensures and certifications. This information may be shared with one or more of our clients and with Top Echelon Contracting Inc. for the sole purpose of verifying / validating your employment history and professional credentials.
  • Professional References

  • Please provide 3 (ideally 4) professional references, with at least 1 or 2 being previous supervisors.
  • Degree Verification

  • Licensure Verification (RN, etc.)

  • (include both "active" and "inactive" states)
  • Current Certification

  • (NOTE: If you have a CPHQ please include the CPHQ certification number.)
  • Are You Legally Authorized To Work In The United States?

  • (choose one below)
  • Permission to Market to Tobacco Free Employers

  • (choose one below)
  • It is the policy and practice of Galileo Search, LLC to provide equal employment opportunity for all employees and candidates for employment without regard to age, sex, race, color, religion, national origin, disability, or sexual orientation, and to observe all applicable requirements of local, state and federal law.
  • Additional Information

  • By 'submitting' this information, I release Galileo Search, LLC. its employees and agents from all liability relating to your obtaining and use of such information and you’re providing such information to prospective employers. I authorize all companies, schools, organizations and other persons to provide such information to you and release them for all liability for doing so.