Application for Employment - DS Pipe & Steel Supply, LLC

Please fill out the form below to apply for Employment.
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Equal access to programs, services and employment opportunities is available to all persons without regard to race, religion, color, sex (including pregnancy), age, ancestry or national origin, disability, marital status, sexual orientation, gender identity, genetic information, or any other basis protected by federal, state, and/or local law.

In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations for the application and/or interview process should notify the Human Resources Department. Examples of reasonable accommodations include making a change to the application process; providing written materials in an alternate format such as braille, large print, or audio recording; using a sign language interpreter; using specialized equipment; or modifying testing conditions.

Name: *

Applicant ID #:

Address:

Telephone #:

Cellular/Other Phone #:

Email Address: *

Position(s) applied for:

Date of Application:

Referral Source (e.g., Walk-in, Job Posting, Company's Website, etc.):

If necessary, best time to call you is: HomeCellular/Other

May we contact you at work? YesNo

If yes, work number and best time to call:

If you are under 18 and it is required, can you furnish a work permit? N/AYesNo

If no, please explain:

Have you submitted an application here before? YesNo

If yes, give date(s) and position(s):

Have you ever been employed here before? YesNo

If yes, give dates:

Is this application a request for reemployment following an extended military leave of absence from this company? YesNo

Are you lawfully authorized to work in the United States? YesNo

Date available for work:

What is your desired salary range or hourly rate of pay?

Type of employed desired: Full-TimePart-TimeEducational Co-OpSeasonalTemporary

Will you relocate if job requires it? YesNo

Will you travel if job required it? YesNo

If they have been explained to you, are you able to meet the attendance requirements of the position? N/AYesNo

Will you work overtime if required? YesNo

If no, please explain

Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)?
This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
YesNoNeed more information about the job's essential functions to respond

Driver's license number required if driving may be required in the job for which you applying:

Have you been bonded? YesNo

Have you ever pleaded "guilty" or "no contest" to, or been convicted of a crime?
NOTE: Answering "yes" to this question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. You are not obligated to disclose expunged charges.
YesNo

If yes, please date(s) and details:

Have you entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company? YesNo

If yes, please explain:

Employment History

Employer:

Telephone #:

Street Address:

City:

State:

Starting Job Title/Final Job Title:

Immediate Supervisor and Title (for most recent position held):

May be contact for reference? YesNoLater

Email:

Why did you leave?

Summarize the Type of Work Performed and Job Responsibilities:

What did you like most about your position?

What were the things you liked least about your position?

Date Employed: to

Compensation (Starting):

Compensation Type: HourlySalary

Commission/Bonus/Other Compensation:

Compensation (Final):

Compensation Type: HourlySalary

Commission/Bonus/Other Compensation:

Employer:

Telephone #:

Street Address:

City:

State:

Starting Job Title/Final Job Title:

Immediate Supervisor and Title (for most recent position held):

May be contact for reference? YesNoLater

Email:

Why did you leave?

Summarize the Type of Work Performed and Job Responsibilities:

What did you like most about your position?

What were the things you liked least about your position?

Date Employed: to

Compensation (Starting):

Compensation Type: HourlySalary

Commission/Bonus/Other Compensation:

Compensation (Final):

Compensation Type: HourlySalary

Commission/Bonus/Other Compensation:

Employer:

Telephone #:

Street Address:

City:

State:

Starting Job Title/Final Job Title:

Immediate Supervisor and Title (for most recent position held):

May be contact for reference? YesNoLater

Email:

Why did you leave?

Summarize the Type of Work Performed and Job Responsibilities:

What did you like most about your position?

What were the things you liked least about your position?

Date Employed: to

Compensation (Starting):

Compensation Type: HourlySalary

Commission/Bonus/Other Compensation:

Compensation (Final):

Compensation Type: HourlySalary

Commission/Bonus/Other Compensation:

Employer:

Telephone #:

Street Address:

City:

State:

Starting Job Title/Final Job Title:

Immediate Supervisor and Title (for most recent position held):

May be contact for reference? YesNoLater

Email:

Why did you leave?

Summarize the Type of Work Performed and Job Responsibilities:

What did you like most about your position?

What were the things you liked least about your position?

Date Employed: to

Compensation (Starting):

Compensation Type: HourlySalary

Commission/Bonus/Other Compensation:

Compensation (Final):

Compensation Type: HourlySalary

Commission/Bonus/Other Compensation:

Explain any gaps in your employment, other than those due to personal illness, injury, or disability:

If not addressed above, have you ever been fired or asked to resign from a job? YesNoLater

If yes, please explain:

Skills and Qualifications

Summarize any special training, skills, languages, licenses, and/or certifications that may assist you in performing the position for which you are applying:

Computer Skills (Include software titles and level of experience, such as basis, intermediate, or advanced.)

Word ProcessingSpreadsheetPresentationE-mailInternet

Please highlight any other computer skills below: :

Educational Background

Starting with your most recent school attended, provide the following information:

School (include City and State) # of Years Completed Completed GPA Class Rank Major/Minor

DiplomaGEDDegreeCertificationOther

DiplomaGEDDegreeCertificationOther

DiplomaGEDDegreeCertificationOther

DiplomaGEDDegreeCertificationOther

References

List names and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Name Title Relationship to You Telephone E-mail # of Years Known

Related Information

When answering these questions, please exclude any information that would reveal race, religion, color, sex (including pregnancy), age, ancestry or national origin, disability, marital status, sexual orientation, gender identity, genetic information, or other similarly protected status.

To what job-related organizations (professional, trade, etc.) do you belong?

List special accomplishments, publications, awards, etc.:

List any relevant volunteer work:

Is there any other job-related information you want us to know about you?

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct.
I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resumé, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.
I understand that this application remain current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time with or without cause with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative of the employer is to make any assurances to the contrary and that no implied oral or written agreements contrary to the forgoing express language are value unless they are in writing and signed by the employer's president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer.
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT RWQUIRE OR DEMAND, AS A CONDITION OR EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYEMTN, THAT AN INDIVIDUAL SUBJECT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEAMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis or his or her race, religion, color, sex (including pregnancy), age, ancestry or national origin, disability, marital status, sexual orientation, gender identity, genetic information, or any other protected status under applicable federal, state, or local law.
I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICATION STATEMENT.

I certify that I have ready, fully understand and accept all terms of the foregoing Applicant Statement.

Name of Applicant

Date

Signature:

Δ

School (include City and State)	# of Years Completed	Completed	GPA Class Rank	Major/Minor
		DiplomaGEDDegreeCertificationOther
		DiplomaGEDDegreeCertificationOther
		DiplomaGEDDegreeCertificationOther
		DiplomaGEDDegreeCertificationOther

Employment History

Skills and Qualifications

Educational Background

References

Related Information

Applicant Statement

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