APPLICATION FOR EMPLOYMENT

 

FUNCTIONAL INDUSTRIES, INC.

P O BOX 336

BUFFALO  MN  55313-0336

(763) 682-4336

 

 


 We consider applicants for all positions without regard to race, color, religion, sex, national origin,

age,marital or veteran status, the presence of a non-job related medical condition or disability,

or any other legally protected status.

 

 


PLEASE PRINT

Position(s) applied for:

Date of application:

 

 

Last Name                                                     First Name                                    Middle Initial                                 

 

 

 

 

 

Address        Street                                           City                      State               Zip Code

 

 

 

 

 

 

Telephone Number(s)                                                Social Security Number

 

 

 

 

How did you learn about us:  ___Advertisement       ___Friend        ___Employment agency

    ___Relative                ___Walk-in      ___Other:____________

 

If you are under 18 years of age, can you provide required proof of your ability to work? __Yes  __No                     

Have you ever filed an application with us before:    If yes, date: ___________              __Yes  __No

Are you currently employed?                                                                                     __Yes  __No

May we contact your present employer?                                                                     __Yes  __No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?                                                                                                                   __Yes  __No

*Proof of citizenship or immigration status will be required upon employment.

On what date would you be available for work?                                          ____________________

Are you available to work: _____Full-time    _____ Part-time    _____Shift work     _____Temporary

Can you travel if a job requires it?                                                                            __Yes  __No

Are you currently on lay-off status and subject to recall?                                             __Yes  __No

Have you been convicted of a felony within the last 7 years?                                       __Yes  __No

Conviction will not necessarily disqualify an applicant from employment.  If yes, explain:__________________________________________________________________________

 

 

EDUCATION

 

Grade School

 High School

College/Univ.

Professional

School Name

and  Location

 

 

 

 

Years Completed

 

 

 

 

Diploma/Degree

 

 

 

 

Course of study

 

 

 

 

 

Describe any specialized training, apprenticeship, skills, and activities:_________________________

_________________________________________________________________________________

 

Describe any honors you have received:_________________________________________________

_________________________________________________________________________________

 

State any additional information you feel may be helpful to us in considering your application:_____

_________________________________________________________________________________

 

Indicate any foreign languages you can speak, read and/or write

 

          Fluent

             Good

          Fair

Speak

 

 

 

Read

 

 

 

Write

 

 

 

 

List professional, trade, business or civic activities and offices held.  You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, disability or other protected status.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

REFERENCES

Please list name, address and telephone number of three references who are not previous employers and who are not related to you.

 

1.     _______________________________________________________________________________

2.     _______________________________________________________________________________

3.     _______________________________________________________________________________

 

Have you ever had any job related training in the United States military?      ____Yes    ____No

If yes, please describe:_______________________________________________________________

 

Are you physically or otherwise unable to perform the duties of the job for which you are applying?

                                                                                                                 ____Yes    ____No   

 

 

 

EMPLOYMENT REFERENCE

Start with your present or last position.  Include job related military service assignments and volunteer activities.  You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

                                                                                                    Employment Dates

1)  Employer                   Address                                Telephone No.       From         To

 

 

 

 

 

Job Title                             Supervisor                            Work Performed             

 

 

 

 

Hourly Rate/Salary

Starting                          Ending                              Reason for Leaving

 

 

 

 

 

                                                                                                    Employment Dates

2) Employer                    Address                                 Telephone No.     From          To

 

 

 

 

 

Job Title                             Supervisor                            Work Performed            

 

 

 

 

Hourly Rate/Salary

Starting                         Ending                              Reason for Leaving

 

 

 

 

 

                                                                                                    Employment Dates

1)  Employer                   Address                                Telephone No.       From         To

 

 

 

 

 

Job Title                             Supervisor                            Work Performed            

 

 

 

 

Hourly Rate/Salary

Starting                          Ending                              Reason for Leaving

 

 

 

 

 

If you need additional space, please attach a separate sheet.

 

How do you feel about persons with disabilities?___________________________________________

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

Why are you interested in working at Functional Industries, Inc.?_____________________________

 

__________________________________________________________________________________

FUNCTIONAL INDUSTRIES’ IS AN EQUAL OPPORTUNITY EMPLOYER

 

 

APPLICANT’S STATEMENT

 

 

I certify that answers given herein are true and complete to the best of my knowledge.

 

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

 

This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

 

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge the employee at any time with or without cause.   It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

 

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in my discharge.  I understand also, that I am required to abide by all rules and regulations of the employer.

 

                       _____________________________   

                      Signature of Applicant                       Date

 

 

 

FOR PERSONNEL DEPARTMENT USE ONLY

 

Arrange interview:     _____Yes      _____No

 

Remarks:_________________________________________________________________________

_________________________________________________________________________________

 

 Interviewer:_______________________________               Date:__________________________       

 

************************************

Employed:    ____Yes      _____No                Date of Employment:__________________________

 

Job Title:_____________________    Hourly Rate/Salary:__________________    Dept.:_________

 

By:___________________________________________           _____________________________

    Name and Title                                                                  Date

 

Notes:___________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

 

 

 

FUNCTIONAL INDUSTRIES’ APPLICANT FLOW SURVEY

APPENDIX B

 

TO ALL APPLICANTS:

 

The information requested in the following questionnaire will not affect you as an applicant.  This information will be used to determine if our recruitment efforts are reaching all segments of the community, and to meet governmental reporting requirements.  This information will not be placed in your personnel file and will not be given to anyone who makes hiring decisions.  We would appreciate your cooperation and assistance in our efforts to ensure Equal Employment Opportunity.

 

*********************************************************************************

 


      PLEASE PRINT CLEARLY       

 

 

 

________________________                Date:__________________

Title of position applied for

 

____________________________               ___________________________               _______ 

Last Name                                                  First Name                                               M.I.

 

________________________________________________________________________________

Street Address                                                City                              State               Zip Code

 

_________  _____   ___________               _____________________________

Social Security Number                              Area Code         Telephone Number

 

Sex:                                                      What race/ethnic group do you consider yourself?

Male:    _____                                        African American___ _        American Indian_____

Female:_____                                        Asian American  _____        Caucasian         _____

                                                            Spanish Surname_____       Other______________

 

Do you have a disability?    _____Yes     _____No      Vietnam Era Veteran?   ____Yes    ____No

 

How did you learn about this job?

 

_____Private Employment Agency             Name:_______________________________________

_____State Employment Agency               Name:_______________________________________

_____Newspaper                                    Name:_______________________________________

_____College/Technical School                 Name:_______________________________________

_____High School                                   Name:_______________________________________

_____Walk In

_____FII Employee (includes all programs/depts.)  Name:________________________________

_____Minority Group Referral Source        Name:_______________________________________

_____Other (be specific)___________________________________________________________

          __________________________________________________________________________

                                                                                                                                  Rev. 2/04