Employment Application

1General Information

2Education

3Legal

4Employment Record

5Submit

6EEO-1 Form

Employment Record

List all employment for the last seven (7) years with the most recent first.
Employer #1
Current / Most Recent Employer
Your Title
Address
Street Address Address Line 2 City State ZIP Code
Employment Start Date
Employment End Date
Starting Pay Rate
Final Pay Rate
Reason for Leaving
Your Responsibilities
Supervisor Name
Supervisor Title
Supervisor Phone Number
Employer #2
Current / Most Recent Employer
Your Title
Address
Street Address Address Line 2 City State ZIP Code
Employment Start Date
Employment End Date
Starting Pay Rate
Final Pay Rate
Reason for Leaving
Your Responsibilities
Supervisor Name
Supervisor Title
Supervisor Phone Number
Employer #3
Current / Most Recent Employer
Your Title
Address
Street Address Address Line 2 City State ZIP Code
Employment Start Date
Employment End Date
Starting Pay Rate
Final Pay Rate
Reason for Leaving
Your Responsibilities
Supervisor Name
Supervisor Title
Supervisor Phone Number
Employer #4
Current / Most Recent Employer
Your Title
Address
Street Address Address Line 2 City State ZIP Code
Employment Start Date
Employment End Date
Starting Pay Rate
Final Pay Rate
Reason for Leaving
Your Responsibilities
Supervisor Name
Supervisor Title
Supervisor Phone Number

Certification and Acknowledgement Statement

Please read the following. If you understand and agree to this statement, click Submit and your application will be complete.
I understand this is an Application for Employment only and is not an offer or commitment to hire. All applicants for employment will be considered without regard to race, religion, color, national origin, sex, pregnancy status, marriage status, age, disability/handicap, veteran status, sexual orientation, or sexual affectation.

I understand that any omission or misrepresentation by me in this application may be cause for immediate dismissal and that any offer of employment is contingent upon satisfactory results of a job-related medical examination where applicable, a urine drug screen by company-designated physician at company expense, where applicable, and a successful background investigation, where applicable. I understand I may be required to take and pass an employment test and/or provide a military discharge certificate before I begin employment.

I understand this application, or any employment with Delaware Dynamics that results from this application, does not create a contract of employment for a fixed period of time. I understand and agree that if I do become employed by Delaware Dynamics, my employment will be at will. This means I have the right to terminate my employment at any time for any reason with or without notice, and the company has the same right. I understand and agree only the Chairman and the Chief Human Resources Officer of Delaware Dynamics has authority to enter into any agreement with me for employment for a specified period of time or to make any agreement with me which is different from at-will employment. Such an agreement must be in writing. No representative of Delaware Dynamics other than the Chairman and the Chief Human Resources Officer of Delaware Dynamics has this authority. I understand Delaware Dynamics employment policies and procedures, whether in oral or written format are merely guidelines for managers and employees, are not contractual in nature, and are not an employment contract of any kind or for any specific duration. I represent I can perform the job for which I am being considered without disclosing to Delaware Dynamics or its employees any confidential information or trade secrets I acquired during my previous employment.
I certify that all information I have provided on this Application for Employment was completed by me, including additional information I have attached, is true and complete to the best of my knowledge. By submitting this form, I agree that I have read, understand and consent to the "Certification and Acknowledgement Statement" above.
Signature*
Date*

General Information

Contact Information

Job Position and Referral

Education

High School

Bachelor or Associate Degree (enter highest)

Technical / Vocational / Military School

Legal

Employment Record

Employer #1

Employer #2

Employer #3

Employer #4

Certification and Acknowledgement Statement

EEO-1 Form

EEO-1 Voluntary Self-Identification Form

Delaware Dynamics Breaks Ground on New Facility to Expand High-Tech Capabilities

Delaware Dynamics and AHP Merkle Announce North American Distribution Agreement