Genesis Press Application for Employment

Applicant Data
Position
First name First name is required. Last name last name is required.
Address Address is required. Address
City City is required.    
State Please select a state. Zip Zip is required.
Phone Phone is required. Other phone
Email Email address is required.Invalid format.Exceeded maximum number of characters. Social Security # SSN# is required.
Date available to start Salary requirements $
If you are under 18 and we require a work permit, can you furnish one? Yes No
If no, please explain
Have you ever worked for this company? Yes No
If yes, when?    
Are you a citizen of the United States? Yes No
If no, are you legally allowed to work in the United States? Yes No
Type of employment desired?
Have you ever pled "guilty", "no contest" or been convicted of a crime? Yes No
If yes, give dates and details
Answering "yes" to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.
Driver's license number if applicable to position
State issued
Who referred you to us?
 

Education
High school Address
# of years completed Did you graduate? Yes No
GPA Class rank
College/University Address
# of years completed Did you graduate? Yes No
Degree Major
GPA Class rank
Other Address
# of years completed Did you graduate? Yes No
Degree Major
GPA Class rank
 

References
Please furnish the names, addresses and telephone numbers of two people to whom you are not related and by whom you have not been employed.
Name A value is required. Phone A value is required.
Address Address
City State
Zip    
       
Name A value is required. Phone A value is required.
Address Address
City State
Zip    
 

Summarize Your Special Skills Or Qualifications

Previous Employment in this Industry
Begin with most recent position
Date of employment: from To
Position held    
Company Company is required. Phone Phone is required.
Address Address
Supervisor Supervisor is required. Supervisor's title Title is required.
Your responsibilities
Starting salary $ Starting title
Ending salary $ Ending title
Reason for leaving
May we contact this employer for a reference? Yes No
       
Date of employment: from To
Position held    
Company Phone
Address Address
Supervisor Supervisor's title
Your responsibilities
Starting salary $ Starting title
Ending salary $ Ending title
Reason for leaving
May we contact this employer for a reference? Yes No
       
Date of employment: from To
Position held    
Company Phone
Address Address
Supervisor Supervisor's title
Your responsibilities
Starting salary $ Starting title
Ending salary $ Ending title
Reason for leaving
May we contact this employer for a reference? Yes No
If possible, please attach your resume

By clicking the "Submit Application" button I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hearby release employers, schools or persons from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.