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Get SC Character Reference Form 2015

A • SC 29211-1329 Phone: 803-896-4544 • Contact.llr@llr.sc.gov • Fax: 803-896-4515 www.llronline.com/ POL/LongTermHealthCare/ CHARACTER REFERENCE • • • Individuals giving a reference cannot be related by blood, marriage or employer/supervisor Three references must be completed as part of the application process. Photocopy this form for the other two References APPLICANT’S NAME: DATES OF ASSOCIATION (length of time): HOW HAVE YOU BEEN ASSOCIATED WITH THE APPLICANT? YES NO BASE.

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