Job Application - Genie Energy Ltd.

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Job Application

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Application for Employment

This Application will remain active for 60 days from the date of application.

1Personal Information

2Employment Desired

4Employment History

5Applicant Affirmation

Personal Information
This field is hidden when viewing the form
Completed Application Date*
MM slash DD slash YYYY
Name*
First Middle Last Maiden
Current Address*
Street Address City

State ZIP Code
Home Phone*
Cell Phone*
Are you authorized to work in the United States on a full-time basis, or only for your current employer?*
- All employers
- Current employer
Note: Federal laws require that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with those laws, all offers of employment are subject to verification of each applicant’s identity and employment authorization. Proof of identity and employment eligibility will be required upon commencement of employment.

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Employment Desired
How were you referred to Genie Energy:*
- Employee Referral
- Agency
- Internet Posting
- Newspaper Ad
- Web Site
- Other
Other*
Name of referring employee*
Position Desired*
Position Type*
- Full Time
- Part Time
- Temporary
Salary Desired*
Will You Relocate if necessary?*
- Yes
- No
Will You travel if necessary?*
- Yes
- No
Date Available to Start?*
MM slash DD slash YYYY
Any family member employed by Genie Energy?*
- Yes
- No
Name*
First Last
Have you ever applied for employment with Genie Energy or an affiliated company?*
- Yes
- No
Application Date*
MM slash DD slash YYYY
What position?*
Have you ever been employed by Genie Energy or an affiliated company?*
- Yes
- No
Employment Start Date*
MM slash DD slash YYYY
Employment End Date*
MM slash DD slash YYYY
What position?*

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Education
Indicate highest level of education completed:*
- GED
- High School
- Associates Degree
- Bachelors Degree
- Masters Degree
- Doctorate
- JD
High School
High School Name
High School Address
High School Degree/Diploma
High School Years Completed
High School Dates Attended
College
College Name
College Address
College Years Completed
College Dates Attended
Graduate School
Graduate School Name
Graduate School Address
Graduate School Years Completed
Graduate School Dates Attended
Technical, Business or Other
Technical, Business or Other Name
Technical, Business or Other Address
Technical, Business or Other Years Completed
Technical, Business or Other Dates Attended
Do you belong to any organizations or professional groups which has a bearing on your qualification for the job for which you are applying?*
- Yes
- No
Please describe:*
Please do not list organization revealing age, race, color, religion, national origin, or any other legally protected status
Do you have any occupational or professional licenses or certificates, or other special training, relevant to the position for which you are applying?*
- Yes
- No
Please describe:*
Do you have any special skills or abilities which relate to the job for which you are applying?*
- Yes
- No
Please describe:*
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?*
- Yes
- No
Please describe:*

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Employment History
Indicate all Permanent, Cooperative, Summer and Voluntary Work. List Most Recent Job First. Account for any gaps in employment.
Company
Company Address
Street Address Address Line 2 City

State ZIP Code
Position Held
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
First name Last Name
Title
Phone
Company
Company Address
Street Address Address Line 2 City

State ZIP Code
Position Held
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
First name Last Name
Title
Phone
Company
Company Address
Street Address Address Line 2 City

State ZIP Code
Position Held
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
First name Last Name
Title
Phone
Company
Company Address
Street Address Address Line 2 City

State ZIP Code
Position Held
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
First name Last Name
Title
Phone
Equal Employment Opportunity
GENIE ENERGY IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS ARE CONSIDERED FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ANCESTRY, MARITAL OR DOMESTIC PARTNERSHIP STATUS, AFFECTIONAL OR SEXUAL ORIENTATION, RELIGION, MILITARY OR VETERAN STATUS, MEDICAL CONDITION, PHYSICAL OR MENTAL HANDICAP OR DISABILITY OR ANY PERCEIVED HANDICAP OR DISABILITY, GENETIC INFORMATION, OR ANY OTHER CHARACTERISTIC PROTECTED BY FEDERAL, STATE OR LOCAL LAW.

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Applicant Affirmation
I certify that all information I have provided in order to apply for and secure work with Genie Energy is true, complete and correct. I understand and further acknowledge that submission of false information on this application or in an employment interview is grounds for disqualification from further consideration for employment, withdrawal of a job offer, or termination of employment, regardless of when the misrepresentation is discovered. I expressly authorize without reservation Genie Energy, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application or through any corresponding resumé or job interview. I hereby waive any and all rights and claims I may have against Genie Energy, its agents, employees or representatives for seeking, gathering and using truthful and non-defamatory information in a lawful manner during the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that an offer of employment extended to me may be conditioned upon my taking a pre-employment drug test and testing negative for the use of drugs. I understand that, should I unreasonably delay, fail or refuse to take a drug test as scheduled, be found to have improperly tampered with, diluted or imported a testing specimen, or receive a confirmed positive test result for drugs, such conditional offer of employment will be rescinded by Genie Energy. I understand that Genie Energy does not unlawfully discriminate in employment and no question on this application will be used for the purpose of limiting or eliminating me or any other applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. If I am hired, I understand that my employment with Genie Energy would be “at will”, meaning that my employment would not be guaranteed for any specific period of time, that I would be free to resign at any time with or without cause and with or without prior notice, and that Genie Energy would have the right to terminate my employment at any time with or without cause and with or without prior notice, except as may otherwise be required by law. I agree that this application and all other document (including Company policies, handbooks, guidelines, practices, benefits or manuals) do not constitute an agreement or contract for employment for any specified period or definite duration, nor do they guarantee me any contractual rights with regard to any term of employment. I also agree that any contract that guarantees me work for a specific period of time must be in writing and signed by the Senior Human Resources Executive of Genie Energy. I understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I also understand that I must be of lawful working age. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature of applicant:*
Name*
First Middle Last
Date*
MM slash DD slash YYYY
Email*

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