Employee Referral Form

  • Must be one of the following positions: RN, LPN.
  • Any employee that refers and external candidate must complete the referral form and send to the Corporate Office (Attention Payroll Manager, 6750 Westown Parkway, Suite 115A, West Des Moines, IA 50266) prior to the newly hired employee hire date.
  • Only one referral bonus can be given per new hire. If a new hire is referred by more than one employee, the first referral received will be the one rewarded if the candidate is hired.
  • An employee is eligible for a referral bonus when an external candidate is hired.
  • Any Administrative STAFF are not eligible to receive a referral bonus.
  • The referral bonus will be paid after the candidate completes 120 days of employment. The referring employee will be paid the bonus in the next full pay period. The bonus will be subject to taxes.
  • Both referring and referred employee must be actively employed with Universal Pediatric Services at the time the bonus is awarded.
Submission Date

Employee Information

Referral Information


6750 Westown Parkway
Suite 115A
West Des Moines, IA 50266


(800) 383-0303

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