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GENESYS Name:
S Y S T E M S I N T E G R A T O R
Post-Offer Employment Questionnaire
Notice: You have been selected for employment by GENESYS and an offer has been extended for such employment.
This questionnaire is a post-offer requirement. Refusal to answer any of the questions could disqualify the Company's
offer of a job opportunity and/or result in your termination.
Post-Offer Employment Questionnaire
If you have answered YES to any of the questions on page (1) please Continuation Sheet
Have you been
Question Date Doctor Treatment Released to 100% Date
No. Injury of Injury Seen Facility Full Duty of Release
Reviewed Initials/Date
Superintendent: Human Resources:
Project Manager: Safety:
3210 E 85th St GENESYS
Kansas City, MO 64132
www.GENESYScorp.net Wednesday, December 28, 2016
Phone: (816) 525-7701
Fax: (816) 525-7720
