REFERRAL FORM

National Systems Inc.
5945 Dallas Parkway
Suite 100
Plano, TX 75093


The total referral bonus amount is $1000 per hire. $500 referral bonus will be paid the pay period following three (3)

months of service by the new hire and another $500 will be paid following six (6) months of service by the new hire.

Please complete the following referral information:

Date

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Employee Name

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Name of Referral

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Address

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Work Telephone

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Home Telephone

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Position Applied For

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FOR OFFICE USE

Hire Date:

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Location of new hire:

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Comment:

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