An Equal Opportunity Employer Fibrebond does not discriminate in hiring or employment on the basis of race, color, religious creed, national origin, sex, age, veteran or disability status. No question on this application is intended to secure information used for discrimination
Please answer all questions. If one does not apply, insert N/A. Incomplete applications will not be considered.
Advertisement (identify ad and publication:
Employee referral (name of employee:
Staffing agency referral (identify agency:
Full Time Part Time Temporary Summer
Yes No
Yes No
Yes No
General Information
Have you ever applied or interviewed for a job with this company in the past? If yes, please give the application date, position applied for, and name of interviewer.
Yes No
Have you been charged with an unresolved criminal charge (have you been charged with a crime that has not yet resulted in a plea of guilty, court trial, or a dropping If yes, please explain:
Note: a yes answer does not automatically disqualify you from employment.
Yes No
Do you have any relatives working for the Company at this time? If yes, please list name(s) and relationship to you:
Yes No
Yes No
Yes No
Yes No
Yes No
Were you in the U.S. Armed Forces? Yes No If yes, what Branch?
Dates of Duty:
Discharge type and date:
Do you have a valid driver’s license? Yes No
List other job-related licenses, certifications, or training you have completed:
State any additional information you feel may be helpful to us in considering your application:
May we contact your present employer? Yes No
May we contact your past employers? Yes No
Have you ever worked for Fibrebond? Yes No
List employment starting with your most recent position.
Dates: Include month & year Name and Location of Employer Job Title and Supervisor List Major Duties Salary or Wages Reason for Leaving
Account for any time during the past 10 years that you were not employed or attending school. Please account for the nature of your activities during these periods.
Dates Reason for Unemployment Nature of Activities while unemployed
Personal References
List three individuals who have knowledge of your work ethic, experience and ability. Do not include relatives or individuals listed in Employment History section.
Name Occupation Phone Number Address, City, State, Zip
By my signature and initials, I promise that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration from employment, and may be justification for my dismissal from employment, if discovered at a later date, regardless of the time lapsed before discovery. I further certify that I, the undersigned applicant, have personally completed this application.
I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
In making this application for employment, it is understood and accepted that as part of the application and employment process, and/or during my employment with Fibrebond, I may be asked to submit to physical examinations which will include testing for alcohol and drugs. By signing this application, I hereby agree to submit to such examinations and tests and release all persons and companies from any liability arising out of such examinations and tests.
I understand that if my employment is terminated by the company for dishonesty, breach of trust, or any criminal acts the authorities may be notified and I may be criminally prosecuted. I also understand that, if hired, I may not hold other employment, nor engage in sales, investments or other activities that create a conflict of interest with my position with this company.
I understand that nothing contained in this employment application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s duly authorized representative.
Applicant’s Signature: Date

Thank you for your interest in employment with Fibrebond. The application you submit will be reviewed and, if based upon the information you have supplied, there is a need to schedule you for a personal interview, you will be contacted by phone or mail. If however, we are unable to consider your application, you will receive no further notice. Applications will remain active for 45 days, after that time a new application must be submitted. Due to the large volume of employment inquiries received, we regret that we are unable to provide a more personal response to your application.

Please review your completed application to ensure you have provide responses to ALL questions. AN INCOMPLETE APPLICATION WILL NOT BE CONSIDERED
We are required by law to collect the following information for Equal Opportunity employment purposes. It will not become part of your personnel record.
(Check Appropriate Category)
Marital Status:
Black or African American
Hispanic or Latino
American Indian or Alaskan
Hawaiian or Pacific Islander
Two or more races
VETERAN STATUS: (Check Appropriate Category)
Disabled Veteran
Veteran of war, campaign or expedition
Noncombat Veteran who earned an Armed Forces Service Medal
Recently Separated Veteran
Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
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Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you

give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that Why are you being asked to complete this form? substantially limits a major life activity, or if you have a history or condition.

Disabilities include, but are not limited to:
  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)
Please check one of the boxes below:
YES, I HAVE A DISABILITY (or previously had a disability)
Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
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Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

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