Reference Request

  • This reference request should be given to a person who has personal knowledge about your employment history, education or character and can attest to your ability to provide in-home supports, Minimally, two references should be from from former or current employers. References CANNOT be from family members. Three references must be submitted before your application will be considered for new hire. Please fill in your name below and then give this form to the person from whom you are requesting a reference. Instruct that person to return this Reference Request back to United Cerebral Palsy of Southern Arizona ("UCPSA") fax: 520-795-3196; email: or by regular mail.
  • Please complete the questions listed below keeping in mind that direct care services are typically performed unsupervised in the home of a person with physical or developmental disabilities. Your time and effort in completing this form is appreciated, and UCPSA will exercise strict confidentiality in regard to you responses within the provisions of the law.