Test

Step 1 of 5

General Information
Date*
MM slash DD slash YYYY
Name*
First Middle Last
Last Four Digits of Social Security Number*
Primary Phone*
Secondary Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Have you lived at your residence for less than five (5) years?*
- Yes
- No
Lived Here How Long?
Previous Address*
Street Address Address Line 2 City State ZIP Code
Applying to:*
- FCC (Indiana), LLC - 555 Industrial Park Road, Portland, IN
- FCC (Adams), LLC - 936 East Parr Road, Berne, IN
- FCC (North Carolina), LLC - 18000 Fieldcrest Road, Laurinburg, NC
- FCC (North Carolina), LLC Friction Paper Plant - 16820 US Highway 401, Laurinburg, NC
If previously employed by FCC, please check all applicable locations OR select “Never Employed by FCC”*
- FCC (Indiana), LLC ‐ 555 Industrial Park Road, Portland, IN
- FCC (Adams), LLC ‐ 936 East Parr Road, Berne, IN
- FCC (North Carolina), LLC ‐ 18000 Fieldcrest Road, Laurinburg, NC
- FCC (North Carolina), LLC Friction Paper Plant ‐ 16820 US Highway 401, Laurinburg, NC
- Never Employed by FCC
Interview Contact Preference (choose one):*
- Email
- Text to Primary Phone
- Text to Secondary Phone
- Call to Primary Phone
- Call Secondary Phone
Interview Scheduling Preferences (date & time):*
1st Choice: 2nd Choice: 3rd Choice:
Type of Work Desired?
Available to Work:*
- 1st Shift
- 2nd Shift
- 3rd Shift
Available to Work:*
- Full Time
- Part Time
Date Available to Work:*
MM slash DD slash YYYY
Salary Desired $:
Per Hour/Week/Month
Number of Work Days absent last year (excluding vacation, holidays, and approved LOA):*
List relatives employed by FCC:
How were you referred?
Are you over the age of 18?*
- Yes
- No
Do you have a valid drivers license?*
- Yes
- No
Were you in the U.S. Armed Forces?*
- Yes
- No
What Branch?
Dat of Duty?
Type of Discharge?

Note: A less than Honorable Discharge will not constitute an automatic bar to employment.
Rank at Discharge?
List Duties and Special Training while in the U.S. Armed Forces:
Have you ever been convicted of a crime of any kind other than a minor traffic violation?*
Note: Existence of a conviction will not constitute an automatic bar to employment. We will consider all appropriate circumstances. Note: No expunged or sealed convictions are required to be divulged.
- Yes
- No
What offenses? Give Date, Place and Disposition.
Are you authorized to work in the United States?*
- Yes
- No
May we contact your previous employer(s)?
- Yes
- No
Please explain:*
Since age 16, have you ever been known by any name, other than the name listed on the first part of this application?
- Yes
- No
Give other name and date changed:*
Can you perform the Essential Functions of the position for which you are applying with or without reasonable accommodations?*
- Yes
- No

Notice
All qualified applicants will receive consideration without regard to age, disability, race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, military status or any status protected by law.

Affidavit

"Neither this application not any statement made to me during the hiring process or thereafter shall be considered a contract of employment of any kind. Where such a contract is intended, I understand that it will be separately entered into and signed by the President of the company. Absent such a contract, I understand that, if hired, my employment will be terminable-at-will, with or without cause or notice, that I am not being employed for any specified or definite period of time, and that this application is not and is not intended to be a contract, offer, statement or confirmation of or for any continued employment. The company may alter, modify, amend, or terminate any of its policies or benefits, both as to active and retired employees, without any notice."

"I certify that the answers given by me to forgoing questions and statements are true and correct without consequential commissions of any kind. I certify that the information and the application is true and understand that misrepresentation or false or omitted facts will result in my termination, regardless of the time of discovery of the company. I agree that the company shall not be liable in any respect if my employment is terminated because of the falsity of statements, answers or omissions made by me in the application for employment. I authorize the companies, schools and other references names above to provide information regarding me and to release personal, academic and other records concerning me."

If I am offered employment prior to a medical examination it is understood by me it is conditioned upon satifactorily passed the medical examination.
Agreement*
- By checking this box, you are saying that you have read and agree that the above statements are true.First Choice
Signature*
Name of Person completing this form if other than applicant:

Institution/School:	Location:	From:	To:	Last Year Completed:	Did You Graduate?	List Degree or Diploma:	Course of Study or Major:	Actions

There are no Entries.

Company	Address	Position/Title:	Start Date:	End Date:	Salary	Per Hour/Week/Month	Supervisor Name:	Describe the Work That You Did:	Reason For Leaving:	Explanation:	Actions

There are no Entries.

Name:	Occupation:	Address:	Phone:	Years Known:	Actions

There are no Entries.

Step 1 of 5

General Information

Education & Training

Skills & Licenses

Employment History

Personal References

Additional Comments

Notice

Affidavit