Certified Nursing Assistant Reference Verification Form

Verify CNA References with Confidence

Hiring the right Certified Nursing Assistant (CNA) is critical to maintaining high standards of care in your nursing home or long-term care facility. This CNA Reference Verification Form helps you gather detailed, structured feedback from previous supervisors and colleagues about a candidate's clinical competence, resident care quality, safety protocols, and interpersonal skills.

Why Use This Template?

This form goes beyond basic employment verification to assess the specific competencies that matter most in elder care settings: dementia and memory care experience, infection control practices, family communication skills, and day-to-day reliability. Whether you're a nursing home administrator, HR manager, or director of nursing, this template streamlines your reference checking process and helps you make informed hiring decisions.

Key areas covered include:

• Resident Care Quality: Direct care skills, compassion, patience with elderly residents
• Safety & Compliance: Adherence to infection control, fall prevention, and regulatory standards
• Dementia & Memory Care: Experience with behavioral challenges, redirection techniques, and person-centered care
• Communication: Ability to work with families, interdisciplinary teams, and document accurately
• Reliability & Professionalism: Attendance, punctuality, work ethic, and ability to handle stress

Streamline Your Hiring Workflow

This form can be sent directly to references via a secure link, eliminating phone tag and ensuring you receive consistent, detailed feedback for every candidate. Responses are automatically organized in your Paperform dashboard, making it easy to compare candidates side-by-side.

For healthcare facilities managing multiple open positions, you can connect this form to your existing HR systems using Stepper to automatically route reference responses to the right hiring manager, flag concerns, or trigger next steps in your hiring workflow—all without manual data entry.

Trusted by nursing homes and senior care facilities nationwide, this template helps you build a team of compassionate, competent CNAs who will provide the highest quality care to your residents.

Get started in seconds — customize the questions to match your facility's values and send to references today.