EMPLOYMENT APPLICATION Delphinus Engineering, Inc. (DEI) is an Equal Opportunity Employer. The company does not discriminate against any individual on the basis of their race, religion, creed, color, sex, national origin, age, disability, veteran status, marital status, status with regard to public assistance, or sexual orientation. INFORMATION FOR APPLICANT An applicant for a position with DEI must comply with the requirements of the U. S. Immigration Reform and Control Act. This law requires that each new DEI employee provide the company s Administrative Services Department with either documentation supporting their identity and authorization to work in the United States, or receipts showing their application for the appropriate documents. This information must be provided within three (3) working days after the employment start date. In the event an individual provides receipts, they will also be required to provide the actual documents to the Administrative Services Department within ninety (90) days after their employment start date. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact human resources at 610-874-9160 or E-mail hr@delphinus.com for assistance. The following documents establish identity only: A drivers license with a photograph or a drivers license which contains identifying information such as name, height, age, sex, color of eyes and address. A state issued I.D. if it contains the individual s photograph or contains personal identifying information. The following documents establish both identity and work authorization: United States Passport. Certificate of Citizenship. Certificate of Naturalization. An Alien Registration Card or Resident Alien Form with the alien s photograph. A Temporary Resident Card or Employment Authorization Card with a picture of the bearer, or an unexpired foreign passport which contains an unexpired stamp which reads processed for I-551 or contains an unexpired Form I-94, as long as the proposed employment does not conflict with any of the restrictions noted on the form. Social Security Card, unless it states that it is not to be used as evidence of work authorization. An unexpired re-entry permit. An unexpired Refugee Travel Document. A certificate of birth or a certificate of birth abroad issued by the U.S. Department of State. An original or certified copy of a birth certificate establishing birth in the United States. DELPHINUS ENGINEERING, INC. 650 Baldwin Tower Eddystone, PA 19022 Phone: (610)874-9160 Fax: (610)874-9166 AN AFFIRMITAVE ACTION EMPLOYER
EMPLOYMENT APPLICATION Requisition : (For Director of Recruiting Use Only) PART I: PERSONAL DATA Basic Employee Information Social Security Number: Prefix: Name: Suffix: (Ms./Mrs./Mr.) (Last) (First) (Middle) (Sr., Jr.,etc.) Preferred Name: Home Address (Primary Residence) Telephone Numbers Street: Home: Apartment : Work: P.O. Box: (optional) Extension: City Other: State/Province: Country (if other an U.S.): U.S. Citizen: Age: (If Under 18.) Has any of your employment been under a different name: Name: (Last) (First) Do you have a relative(s) or friend(s) who work for DEI: (Middle) If yes, What is their name : What is their relationship to you?: PART II: EDUCATION, SKILLS & TRAINING High School School Information Check One Diploma Year Completed: School Name: GED N/A State: College Degree: School Name: Year: Major: Minor:
Special Skills / Certifications / Certificates Description: Years of Relevant Experience: Date Obtained: Training: Description: Start: Date : End: Membership of Professional Organizations / Professional Licenses: Name of Professional Organization Years of Membership Rank / Postion Held: Professional / Technical Publications, Patents: Professional / Technical Publications, Patents Title Place of Publication Date Position (s) Applied For: (1) PART III: EMPLOYMENT INFORMATION (2) (3) Are You Available for Work: Full Time Part Time Temporary If Part Time, Specify Days and Hours You Are Able to Work: If this application is accepted, on what date will you be able to start work?: What Annual Salary or Hourly Wage do you expect?: Have you ever been convicted of a Felony? Have you ever been convicted of a crime or received a verdict of anything other than not guilty in any criminal investigation or proceeding?* If "", attach a seperate piece of paper that states when conviction occured, circumstances, and any other information pertaining to your rehabilitation * NOTE: Do not include: (1) Incidents for which records have been expunged; or (2) Traffic violations for which the fine was $100 or less. A criminal offense will not necessarily bar employment. Factors such as the passage of time since offense, the nature of the violation and the extent of rehabilitation will be taken into account in determining the jobrelatedness of the offense. Are you legally eligible for employment in the United States?
PART IV: PRESENT / PREVIOUS EMPLOYERS Previous Employment with the U.S. Government: If you held a postion in the Federal Governmentat the GS-13 level or above and left the government on or after April 16, 1987, provide your last date of employment, agency where employed, and postion held. Date: Agency: Position Held: Present Employer: May we ask your present employer for a reference? (Check One) Name of Employer: Date From: To: (MM/DD/YYY) Address: Position Held: Annual Salary / Hourly Wage: Start: End: Describe the responsibilities of your position: Name of Immediate Manager: Reason(s) for Leaving: Previous Employer: (list most current first) May we ask your previous employer for a reference? (Check One) Name of Employer: Dates From: To: (MM/DD/YYY) Address: Position Held: Annual Salary / Hourly Wage: Start: End: Describe the responsibilities of your position: Name of Immediate Manager: Reason(s) for Leaving: Previous Employer: (list most current first) May we ask your previous employer for a reference? (Check One) Name of Employer: Dates From: To: (MM/DD/YYY) Address: Position Held: Annual Salary / Hourly Wage: Start: End: Describe the responsibilities of your position: Name of Immediate Manager: Reason(s) for Leaving:
PART V: REFERENCES Indicate if reference is related to you: Relationship: Indicate if reference is related to you: Relationship: Indicate if reference is related to you: Relationship: Indicate if reference is related to you: Relationship:
PART VI: CONDITIONS OF EMPLOYMENT I understand that if I receive an offer of employment from DEI that: 1. The offer is not valid unless It is in writing and is signed by an offical of the company. 2. My employment at DEI will be on an "at will" basis. This means that either DEI or I may end the employment relationship at any time and for any reason, with or without notice. 3. thing in an offer of employment letter, in any other documents I may receive from or provide to DEI, or in any other materials DEI may give to me either before or after my employment begins, may be construed to limit the at-will nature of my employment. 4. one at DEI has the authority to modify the at-will nature of my employment relationship, whether orally or in writing. 5. I may be required to take a job related ability test for the purpose of judging my qualifications for a particular position. 6. An offer of employment is contingent upon satisfactory completion of three reference checks and the verification of other information contained in this application. 7. That any misrepresentation or omission of fact by me on this application, or in any other documents or forms that are provided to my to secure employment with DEI, will be cause for the company to either reject my application and/or terminate my employment with the company. 8. My employment is contingent upon me signing statements indicating my understanding of, and willingness to comply with: DEI's Alcohol and Drug Free Workplace Policy; Proprietary Information Agreement Policy; and E-mail, Computers, and other Communications Equipment Policy. 9. In accordance with the Immigration Reform and Control Act of 1986, I will be required to provide the company's Administrative Services Department with either documents supporting my identity and authorization to work in the United States, or receipts showing that I have applied for the appropriate documents. ACKNOWLEDGEMENT AND CERTIFICATION I acknowledge that I have read and understand the conditions of employement set forth above. I certify that the information provided in this Employment Application is complete and true. I authorize DEI to take any action necessary to verify the accuracy of the information in this application. Signature of Applicant: Date:
PART VII: ADDITIONAL INFORMATION (List any relevant additional information that is not provided elsewhere in this application) PART VIII: FOR USE BY THE ADMINISTRATIVE SERVICES DEPARTMENT Date received: Entered Into Deltek: Basic Employee Setup: Address/Phones Educational, Skills & Training Data: Degrees Course Skills Professional Organizations Entered By: Date filed in personal record: (Admin. Serv. Dept) Date Entered: