genesis staffing


I have submitted the attached form to Genesis Staffing, Inc. for the purpose of obtaining assistance in securing permanent, temporary, or contract employment.  I understand that I will never be charged a fee by Genesis Staffing, Inc. or any of its divisions.  I acknowledge that the use of this form, and my filling it out, does not indicate that any of its divisions to further process my application.  I certify as to the accuracy of the matters set forth herein and in any resume and understand that any misstatement of fact may cause me to be refused employment or lose my employment.

I hereby authorize Genesis Staffing, Inc. and its divisions and agents to make such investigations and inquire into my employment and educational history and other related matters as may be necessary in arriving at an employment decision.  I hereby release employers, schools, and other persons from all liability in responding to inquiries connected with my application and I specifically authorize the release of information by any schools, business, individuals, services or other entities listed by me in this form.  Furthermore, I authorize Genesis Staffing, Inc. and its divisions and agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.  I authorize Genesis Staffing, Inc. to forward to a Genesis Staffing, Inc. client to whom you introduce me any reference information or Consumer Report Information.  I expressly waive any and all claims against Genesis Staffing, Inc. arising from the reference information, the Consumer Report Information or the communication of any such information about me to any Genesis Staffing, Inc. client or potential client.


SIGNATURE: ______________________________

DATE: ______________________________

PRINT NAME: ______________________________

I have read and agree to the terms and conditions of the applications addendum.