This government document is issued by Department of State Hospitals (DSH) for use in California
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https://www.google.com/url?client=internal-element-cse&cx=001779225245372747843:zqiqummuqzk&q=https://www.dsh.ca.gov/Jobs/docs/Classifications/RN_Auth_Obtain_Emp_Ref_Info.pdf%3F%3D0731&sa=U&ved=2ahUKEwiqtbfhvpHyAhVvpYsKHdgBD4A4ChAWMAh6BAgHEAE&usg=AOvVaw3usyRrZqLm7V3idTIt_Qcx