The Aya Healthcare reference form is a one-page performance evaluation that a former supervisor fills out to verify your clinical skills and work history, and Aya typically needs two of them completed by direct supervisors before you can be submitted to a hospital for an assignment.1Aya Healthcare. Travel Nursing Compliance and Licensing The completed form is returned to Aya by fax at 858.939.1828 or by email to references@ayahealthcare.com.2Aya Healthcare. Performance Evaluation Reference References are the single most common place a travel credentialing file stalls, so the sooner you line yours up, the sooner you can be submitted for jobs.
Who Can Serve as Your Reference
The form is built for supervisors who directly oversaw your clinical work. Aya lists acceptable titles on the form itself: Nurse Manager, Charge Nurse, Supervisor, Director of Nursing, and Assistant Director of Nursing.2Aya Healthcare. Performance Evaluation Reference The form asks the referee whether they supervised you directly, and a “No” answer weakens the reference considerably.
The broader industry standard is at least two supervisory clinical references covering a minimum of one year of experience within the previous three years in the specialty you’re applying for. Peer references from coworkers at your same level don’t count the same way, and references from recruiters, instructors, or personal contacts are not accepted for credentialing.3BluePipes. How to Handle References as a Travel Nurse Some hospitals are stricter than Aya’s baseline and will reject a Charge Nurse, requiring a Unit Manager or above. Ask your recruiter whether the facility you’re targeting has those tighter rules.
References also expire. Agencies and facilities generally require references to be less than two years old; anything older won’t be accepted for new submissions.4Anders Group. Essential Guide to Travel Nursing References Tips for Success A strong reference from four years ago won’t help you.
What the Form Asks Your Supervisor
Your supervisor fills out the entire form. You don’t touch it. It has six sections.2Aya Healthcare. Performance Evaluation Reference
Candidate Information
Your name, the profession you held while working with the referee (RN, CNA, PT, OT, SLP, or other), your specialty, and approximate employment dates by month and year. The form also asks for the average nurse-to-patient ratio, the number of beds on the unit, and the total beds in the facility. Those unit-level details let hospital clients judge whether your experience matches the acuity of the assignment.
Facility Contact Information
The referee’s own name, title, work and mobile phone numbers, work email, facility name, and city and state. Aya’s credentialing team uses this to confirm the referee actually works or worked at the facility. A personal email where a work email is expected, or a facility name that doesn’t match employment records, can trigger follow-ups that slow your file.
Travel Assignment Evaluation
Four yes/no questions: whether you worked a travel assignment, served as a charge nurse, held a supervisory role, and whether the referee would work with you again. That last one carries real weight with hospitals reviewing your profile.
Experience Checklist
An open area for the referee to note specialized experience, such as ventilator management, chemotherapy administration, or specific electronic health record systems. This is where distinguishing experience for a particular unit gets flagged.
Performance and Attributes Ratings
The core of the form is a grid of eight clinical competencies, each rated 3 (Above Standard), 2 (Meets Standard), 1 (Below Standard), or N/A:
- Provides competent clinical care
- Follows facility policies and procedures
- Flexibility and adaptability
- Adaptability when communicating with staff
- Attendance and punctuality
- Overall professionalism
- Communicates effectively with patients, family, and staff
- Completes accurate documentation of patient care
A row of 2s is fine. It means you meet the standard. A single 1 anywhere is likely to raise questions in credentialing review. If the referee can’t speak to a category, N/A is better than guessing.
Strengths and Certification
An open text field for the referee to describe strengths that would make you successful in another clinical role, then a certification box, printed name, and date.2Aya Healthcare. Performance Evaluation Reference
How to Return the Completed Form
Your supervisor sends the finished form back to Aya one of two ways: fax to 858.939.1828 or email to references@ayahealthcare.com.2Aya Healthcare. Performance Evaluation Reference The PDF is available through Aya’s portal and can be printed, filled by hand, and scanned or faxed. Your recruiter can also send a digital link directly to the referee’s email so they can fill it out and submit it online without printing anything.
Once Aya receives the form, the credentialing team reviews it for completeness and verifies the referee. That can include checking that the email domain matches the facility, or contacting the facility directly. Mismatched dates, a facility name that doesn’t match records, or a referee whose employment can’t be confirmed will all generate follow-up requests that delay your file.
How to Keep References From Stalling Your File
Supervisors are busy, and many healthcare employers restrict staff from giving individual references at all, allowing only neutral verification of dates and salary.3BluePipes. How to Handle References as a Travel Nurse If you move between assignments often, you also burn through references quickly, because every new agency verifies them independently.
Ask supervisors before you leave an assignment whether they’ll serve as a reference. A direct ask means they’re expecting the form instead of ignoring an unfamiliar email months later. Stay in light contact after you leave; a supervisor who remembers you responds faster than one trying to place your name.3BluePipes. How to Handle References as a Travel Nurse
You can also ask a supervisor to complete a clinical evaluation while you’re still on the assignment, when your work is fresh. Hand them a blank Aya form or a generic evaluation. Some agencies and hospitals accept a pre-completed evaluation at face value, saving time on both ends.3BluePipes. How to Handle References as a Travel Nurse Ask your recruiter for copies of any completed evaluations so you have them for future agencies.
Where the Reference Fits in Your Credentialing File
The reference form is one piece of a larger file. Aya also requires a current license, specialty certifications, blood work and vaccinations, TB testing, a physical exam, a drug screen, and a background check, and generally expects at least one year of specialty experience, typically in a hospital, before working with you.1Aya Healthcare. Travel Nursing Compliance and Licensing For scale, Aya’s per diem compliance documentation step alone takes 10 to 14 business days, with the full process running several weeks from application to orientation.5Aya Healthcare. Per Diem Credentialing Process Late references push the whole timeline back. Once your references and the rest of your compliance items are verified, your recruiter can submit your profile to hospital clients, and offers can start coming in.