Employment Application from Genacta

Genacta 2207 East Tudor Road Suite 33 Anchorage, AK 99508 Phone: 907-644-7952 Toll Free: 888-644-7952 Fax: 907-644-7953 eMail: info@genacta.com Web site: www.genacta.com		It is the policy of this facility to provide equal opportunity to persons regardless of race, religion, age, gender, disability or any other classification in accordance with federal, state, and local statutes, regulations, and ordinances. This application to be active for a period of 90 days only

Date *		Phone Number *
First Name *	Middle Initial *	Last Name *
Street Address *
City *		State *	Zip *
Salary Requirement *
Please list your licenses, certifications, or other information*
Select position applying for*
Type of Position *	Full Time	Part Time	PRN
Are you legally authorized to wok in the U.S? *		No	Yes
Date available for work *		Are you related to another Genacta employee? *
Are you able to perform the essential, job related functions of the position for which you are applying with or without accommodations?		If overtime work is required periodically, does this pose a problem for you? *
Have you ever been convicted of, been given probation or deferred adjudication in lieu of sentencing, or pled no contest, for any offense other than a minor traffic violation? *