Employment Application Step 1 of 5 20% Employment ApplicationPlease note that any field marked with an asterisk (*) is required for submitting application.Submit this application to:* L-A Electric Premier Communications Residential Electrical Systems Date Date Format: MM slash DD slash YYYY Position Sought:How did you learn about the position?Upload your resume or cover letter here. (.pdf or .docx files) Drop files here or Accepted file types: pdf, docx. Your InformationFull Name*Street Address*Address Line 2City*State / Province / Region*ZIP / Postal CodeCountry* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Primary Phone*Secondary PhoneEmail* Are you over 18 years of age?*YesNoWhat date would you be available to start work? Date Format: MM slash DD slash YYYY Desired Wage/Salary $Have you ever been convicted of a felony?*YesNoIf yes, please describe circumstances:Have you ever been involuntarily terminated or asked to resign from any position of employment?*YesNoIf yes, please describe circumstances:If selected for employment, are you willing to a pre-employment drug screening test?*YesNoDo you have reliable transportation to work?*YesNoAre you willing to work overtime?*YesNo EducationSchool NameYears AttendedLocation (City, State)Degree ReceivedMajorOther training, certifications, or licenses held:List any other pertinent education information to the position you are seeking: Add Another School? Education 2School NameYears AttendedLocationDegree ReceivedMajor Add Another School? Education 3School NameYears AttendedLocationDegree ReceivedMajor References: Please list (3)Reference 1NameBusinessPhoneYears knownReference 2NameBusinessPhoneYears knownReference 3NameBusinessPhoneYears known Employer 1Employer NameJob TitleDates EmployedPrior position held within company (if any)LocationSupervisorPhoneStarting SalaryEnding SalaryReasons for leavingDuties Performed Add An Employer? Employer 2Employer NameJob TitleDates EmployedPrior position held within company (if any)LocationSupervisorPhoneStarting SalaryEnding SalaryReasons for leavingDuties Performed Add An Employer? Employer 3Employer NameJob TitleDates EmployedPrior position held within company (if any)LocationSupervisorPhoneStarting SalaryEnding SalaryReasons for leavingDuties Performed Acknowledgment and AuthorizationBy clicking submit, I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization L-A Electric is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of L-A Electric.