Contractor Onboarding/Offboarding - WF - Formstack

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DELAWARE COUNTY INTERMEDIATE UNIT AND

DELAWARE COUNTY TECHNICAL SCHOOLS

CONTRACTOR ONBOARDING AND OFFBOARDING

Today's Date*

https://delawarecountyintermediateunit.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Please choose the appropriate selection below:*

DCIU DCTS

Please choose the appropriate selection below:*

Contractor Onboarding Contractor Termination Existing Contractor Name Change

Date of Hire*

https://delawarecountyintermediateunit.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Date of Termination*

https://delawarecountyintermediateunit.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Online Services *

DCIU Email IEP Writer - School Age STaR PELICAN No Online Services

Name of Preparer*

First Name*

Last Name*

Email of Preparer*

Contractor Name*

First Name*

Last Name*

Contractor New Name*

Contractor Ethnicity

H - Hispanic or Latino N - Not Hispanic Or Latino

Contractor Race

Gender

M F

Contractor Email Address

Contractor Phone Number

Contractor's Emergency Contact Name

Contractor's Emergency Contact Phone Number

Job Title*

Please type out full name of position

Building Location*

Other Building Location*

Department*

Other Department*

Agency Name*

If Independent, indicate "Independent"

Other Agency*

Agency Phone Number

Agency Email Address

Agency Supervisor*

If Independent, indicate NA

Please confirm presence of ALL documents below:

Copy of COVID-19 Vaccination Card (Do Not Upload CDC Card) Proof of Exemption Child Abuse Clearance FBI Criminal Background Check (fingerprinting) PA Criminal History Check Acceptable Use Policy Document Signed Arrest/Conviction Report and Certification Form (Act 82 Form)

ALL DOCUMENTS MUST BE MAINTAINED LOCALLY BY THE PROGRAM

Internet Access, Email & Network Acceptable Use Policy

DCIU Supervisor*

Service Desk - DCIU Email

Username*

Default Password

Inactive as of Termination Date*

Yes

Initials and Date*

Contractor/Printer #

If Applicable

Comments

IEP Writer/STaR

Username*

Default Password

Inactive as of Termination Date*

Yes

Initials and Date*

Comments

PELICAN

Username*

Inactive as of Termination Date*

Yes

Initials and Date*

Comments

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