Genesis Alliance - Online Application

Note: GAFMW, LLC. will not consider incomplete applications.

How did you learn about this position?

Have you ever filed an application with GAFMW, LLC. before? Yes No

Do any of your friends or relatives, other than a spouse, work here? Yes No

Have you ever been employed with GAFMW, LLC. before? Yes No

Are you at least 18 years of age? Yes No

If you are under 18 years of age, can you provide proof of your eligibility to work? Yes No

Do you have proof of your legal right to accept employment? Yes No

Are you currently employed? Yes No

If yes, may we contact your current employer? Yes No

Will you travel if a job requires it? Yes No

Will you work overtime? Yes No

Have you ever been convicted of a crime?
Note: A conviction record will not necessarily disqualify you from employment. ALL positions at GAFMW, LLC. require a Criminal Background Check.

Yes No

Are you capable of performing, with or without reasonable accommodation, the essential duties of the job for which you are applying? Do not answer unless you have read the job description. Yes No

If yes, give date and position:

Regular Full Time Regular Part-time at Temporary/Seasonal Full Time

Temporary/Seasonal Part-time at Mornings Afternoons

Evenings Weekends Sundays

Education and Training

School

High School

Diploma/Degree Yes No

Undergraduate School

Diploma/Degree Yes No

Graduate School

Diploma/Degree Yes No

Other (Specify)

Diploma/Degree Yes No

Please state any additional information and skills you feel may be helpful to us in considering your application:

Work Experience – complete this section even if you have a resume attached

Begin with your current or last job. Include any job-related military service assignments and volunteer activities.
You may exclude any organizations that indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer

Address
Dates Employed

Hourly/Salary Rate
Work Performed/Responsibilities

Supervisor & Telephone Number(s)

Job Title

May We Contact? Yes No

Reason for Leaving

Employer Address	Dates Employed Hourly/Salary Rate	Work Performed/Responsibilities
Supervisor & Telephone Number(s) Job Title		May We Contact? Yes No Reason for Leaving

Employer Address	Dates Employed Hourly/Salary Rate	Work Performed/Responsibilities
Supervisor & Telephone Number(s) Job Title		May We Contact? Yes No Reason for Leaving

Professional/Personal References – Do not include family members

Name

Name

Name

Address & Phone Number

Address & Phone Number

Address & Phone Number

Occupation

Occupation

Occupation

Applicant’s Certification – please read carefully before signing this application

GAFMW, LLC. is an equal opportunity employer and will consider applicants for all positions without regard to race, age, color, religion, marital status, national origin, disability, veteran status or any other legally protected status.

No applicant will be rejected as a result of an impairment that, with reasonable accommodation, does not prevent performance of the work.

GAFMW, LLC. I will not tolerate sexual harassment or harassment on the basis of any protected class status in the workplace.

I understand that, if selected, I will be required to provide proof of my identity and legal right to work in the United States prior to actual employment at GAFMW, LLC.

I certify that I have answered truthfully and have not knowingly withheld information relative to my application. I understand that any misrepresentation or material omission on the application will result in my being eliminated from further consideration. I further understand that, if accepted for employment, any misrepresentation or material omission that becomes known to GAFMW, LLC. may result in immediate termination of my employment.

I hereby authorize all previous employers and supervisors, including all persons with and for whom I have worked, to give GAFMW, LLC. any and all information regarding me and my previous employment. I release GAFMW, LLC. and all previous employers and supervisors from liability for any damages that may result from furnishing information to GAFMW, LLC.

In consideration of my employment, I agree to adhere to all existing and future instruction, rules, and policies of GAFMW, LLC. I also understand that GAFMW, LLC. reserves the right to change wages, hours and working conditions as deemed necessary and that no representative of GAFMW, LLC. has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.

I understand that all employees of GAFMW, LLC., with respect to length of employment, are considered to be “at will.” This means that I may terminate my employment with GAFMW, LLC. at any time, without notice, without liability, for any extended period. Similarly, GAFMW, LLC. may terminate my employment with GAFMW, LLC. at any time without notice, without liability, for any extended period. There is no guaranteed length of employment for any employee. Similarly. Any representation by any agent or employee of GAFMW, LLC. to the contrary is not authorized or binding upon GAFMW, LLC. unless in writing and signed by the President of GAFMW, LLC.

I have read and reviewed the above certification statements and other information provided on the application.