Employment Opportunities

Please complete the form below and we will get back to you if a position is available.

Name * First Last
Address
Street Address Address Line 2 City State Zip Code
Phone * ### - ### - ####
Email Address *
Which position are you applying for? *
If you chose “Other” in box above please indicate position desired other than choices shown.
If you indicated “Electrician” above you need to be currently certified as an Electrician with the State of California. Please list your current Electrician certification number and expiration date below.
License # Expiration Date
Have you ever applied with LEI before?
Yes No
If yes, what year and position?
Do you have any friends or relatives employed by LEI?
Yes No
If yes, state name and relationship.
Why are you applying for work at LEI?
Maximum Allowed: 50 characters. Currently Used: 0 characters.
If hired, would you have reliable means of transportation?
Yes No
Are you at least 18 years of age? (If under 18, hire is subject to verification that you are of minimum legal age.)
Yes No
If hired, can present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?
Yes No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
Yes No
If no, describe the functions that cannot be performed?
Maximum Allowed: 50 characters. Currently Used: 0 characters.

(Note: We comply with the ADA and consider reasonable accomodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? Convictions for marijuana-related offenses that are more than (2) years old need not be listed.
Yes No
If yes, state the nature of the crime(s). When and where convicted, and deposition of the case?
Maximum Allowed: 50 characters. Currently Used: 0 characters.

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however be considered.
Education, Training and Experience
High School
Address
Street Address Address Line 2 City State Zip Code
No. of years completed:
Did you graduate?
Yes No
Degree or Diploma
College/University
Address
Street Address Address Line 2 City State Zip Code
No. of years completed:
Did you graduate?
Yes No
Degree or Diploma
Vocational/Business School
Address
Street Address Address Line 2 City State Zip Code
No. of years completed:
Did you graduate?
Yes No
Degree or Diploma
Other Training
Address
Street Address Address Line 2 City State Zip Code
No. of years completed:
Did you graduate?
Yes No
Degree or Diploma
Employment History

List below all present and past employment, starting with your most recent employer (last ten years is sufficient). Account for all periods of unemployment. You must complete this section, even if attaching resume.
Employer #1
Name of Employer
Phone Number ### - ### - ####
Type of Business
Supervisors name
Address
Street Address Address Line 2 City State Zip Code
Dates of employment from/to
Weekly pay starting
Weekly pay ending
Your position
Your duties
Reason for leaving
My we contact this employer for a reference?
Yes No
Employer #2
Name of Employer
Phone Number ### - ### - ####
Type of Business
Supervisors name
Address
Street Address Address Line 2 City State Zip Code
Dates of employment from/to
Weekly pay starting
Weekly pay ending
Your position
Your duties
Reason for leaving
My we contact this employer for a reference?
Yes No
Employer #3
Name of Employer
Phone Number ### - ### - ####
Type of Business
Supervisors name
Address
Street Address Address Line 2 City State Zip Code
Dates of employment from/to
Weekly pay starting
Weekly pay ending
Your position
Your duties
Reason for leaving
My we contact this employer for a reference?
Yes No
Employer #4
Name of Employer
Phone Number ### - ### - ####
Type of Business
Supervisors name
Address
Street Address Address Line 2 City State Zip Code
Dates of employment from/to
Weekly pay starting
Weekly pay ending
Your position
Your duties
Reason for leaving
My we contact this employer for a reference?
Yes No
Employer #5
Name of Employer
Phone Number ### - ### - ####
Type of Business
Supervisors name
Address
Street Address Address Line 2 City State Zip Code
Dates of employment from/to
Weekly pay starting
Weekly pay ending
Your position
Your duties
Reason for leaving
My we contact this employer for a reference?
Yes No
References

List below three persons not related to you who have knowledge of your work performance within the last three years.
Reference #1
Name First Last
Phone Number ### - ### - ####
Address
Street Address Address Line 2 City State Zip Code
Occupation
No. years acquainted
Reference #2
Name First Last
Phone Number ### - ### - ####
Address
Street Address Address Line 2 City State Zip Code
Occupation
No. years acquainted
Reference #3
Name First Last
Phone Number ### - ### - ####
Address
Street Address Address Line 2 City State Zip Code
Occupation
No. years acquainted

I HEREBY CERTIFY THAT I HAVE NOT KNOWINGLY WITHHELD ANY INFORMATION THAT MIGHT ADVERSELY AFFECT MY CHANCES FOR EMPLOYMENT AND THAT THE ANSWERS GIVEN BY ME ARE TRUE AND CORRECT TO THE BEST OF KNOWLEDGE. I FURHTER CERTIFY THAT I, THE UNDERSIGNED APPLICANT, HAVE PERSONALLY COMPLETED THIS APPLICATION. I UNDERSTAND THAT ANY OMISSION OR MISSTATEMENT OF MATERIAL FACT ON THIS APPLICATION OR ON ANY DOCUMENT USED TO SECURE EMPLOYMENT SHALL BE GROUNDS FOR REJECTION OF THIS APPLICATION OR FOR IMMEDIATE DISCHARGE IF I AM EMPLOYED, REGARDLIESS OF THE TIME ELAPSED BEFORE DISCOVERY.

I HEREBY AUTHORIZE LASER ELECTRIC, INC., TO THOROUGHLY INVESTIGATE MY REFERENCES, WORK RECORD, EDUCATION AND OTHER MATTERS RELATED TO MY SUITABILITY FOR EMPLOYMENT AND, FURTHER AUTHORIZE THE REFERENCES I HAVE LISTED TO DISCLOSE TO THE COMPANY ANY AND ALL LETTERS, REPORTS AND OTHER INFORMATION RELATED TO MY WORK RECORDS, WITHOUT GIVING ME PRIOR NOTICE OF SUCH DISCLOSURE. IN ADDITION, I HEREBY RELEASE THE COMPANY, MY FORMER EMPLOYERS AND ALL OTHER PERSONS, CORPORATIONS, PARTNERSHIPS AND ASSOCIATIONS FROM ANY AND ALL CLAIMS, DEMANDSOR LIABILITIES ARISING OUT OF OR IN ANY WAY RELATED TO SUCH INVESTIGATION OR DISCLOSURE.

I UNDERSAND THAT NOTHING CONTAINED IN THE APPLICATION, OR CONVEYED DURING ANY INTERVIEW WHICH MAY BE GRANTED OR DURING MY EMPLOYMENT, IF HIRED, IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN ME AND THE COMPANY. IN ADDITION, I UNDERSTAND AND AGREE THAT IF I AM EMPLOYED, MY EMPLOYMENT IS FOR NO DEFINITE OR DETERMINABLE PERIOD AND MY BE TERMINATED AT ANY TIME, WITH OUR WITHOUT PRIOR NOTICE, AT THE OPTION OF EITHER NYSELF OR THE COMPANY AN DHTAT NO PROMISES OR REPRESENTATIONS CONTRARY TO THE FOREGOING ARE BINDING ON THE COMPANY UNLESS MADE IN WRITING AND SIGNED BY ME AND THE COMPANYS DESIGNATED REPRESENTATIVE.

SHOULD A SEARCH OF PUBLIC RECORDS (INCLUDING RECORDS DOCUMENTING AN ARREST, INDICTMENT, CONVICTION, CIVIL JUDICATION ACTION, TAX LIEN OR OUTSTANDING JUDGMENT) BE CONDUCTED BY INTERNAL PERSONNEL EMPLOYED BY THE COMPANY. I AM ENTITLED TO COPIES OF ANY SUCH PUBLIC RECORDS OBTAINED BY THE COMPANY UNLESS I MARK THE CHECK BOX BELOW. IF I AM NOT HIRED AS A RESULT OF SUCH INFORMATION, I AM ENTITLED TO A COPY OF ANY SUCH RECORDS EVEN THOUGH I HAVE CHECKED THE BOX BELOW.

I WAIVE RECEIPT OF A COPY OF ANY PUBLIC RECORD DESCRIBED IN THE PARAGRAPH ABOVE

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Employment Opportunities

Education, Training and Experience

Employment History

References

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