Page 2 - NEW-Missouri-Office
P. 2
GENESYS Name:
S Y S T E M S I N T E G R A T O R
Pre-Offer Employment Questionnaire
Notice: GENESYS may conduct drug testing of applicants. Should the Company consider you for employment, you
may be contacted regarding the time and location of the pre-employment drug test. Refusal to take the drug test could
disqualify you from further consideration for a position.
Please complete all spaces on this application. PRINT clearly.
LastName FirstName MI
Street Address City State Zip
Primary Contact Phone Emergency Contact Person Emergency Phone Social Security Number:
Union Affiliation (Millwright, Ironworker, Operator, Laborer, etc.) Local Union Number
Direct Deposit YES NO Checking Savings
Bank Routing Number Account Number (Circle One)
For Direct Deposit, you must include a voided check/deposit form. This ensures your account information is correct.
Note: A "Yes" response to any of the following questions does not automatically disqualify a job applicant from further
consideration. Each application is evaluated relative to the job being sought.
1 Have you ever been convicted of a felony? Y N
If 'Yes', Please explain:
2 Are there any felony charges pending against you? Y N
If 'Yes', Please explain:
3 Have you ever been previously employed by GENESYS? Y N
If 'Yes', Please explain:
Note: Employment in the Manufacturing and/or Field Installation Departments may require the ability to perform necessary
minimal physical demands. Please indicate your ability to do the following tasks by initialing the appropriate line.
1 Can you lift and carry 50 pounds? Able Unable
2 Can you easily climb 2 flights of stairs? Able Unable
3 Can you stand all day on hard concrete? Able Unable
4 Can you stoop or squat with ease? Able Unable
5 Can you work in extreme environments? (i.e. outside in cold winter or hot Able Unable
summer conditions)
GENESYS Superintendent Use Only
GENESYS Job # Start Date DAYS / NIGHTS (circle one)
Class Journeyman / Welder / Foreman / General Foreman (circle one) Apprentice %
Supervisor Signature
3210 E 85th St GENESYS
Kansas City, MO 64132
www.GENESYScorp.net Wednesday, December 28, 2016
Phone: (816) 525-7701
Fax: (816) 525-7720
