{"id":1061,"date":"2022-11-09T21:12:47","date_gmt":"2022-11-09T21:12:47","guid":{"rendered":"https:\/\/lwr.esinc.org\/?page_id=1061"},"modified":"2022-11-09T21:13:09","modified_gmt":"2022-11-09T21:13:09","slug":"application","status":"publish","type":"page","link":"https:\/\/lwr.esinc.org\/application\/","title":{"rendered":"Application"},"content":{"rendered":"<div data-uniq='65f2b49293a35' class='uniq-65f2b49293a35 formcraft-css form-live align-center'><script> window.formcraftLogic = window.formcraftLogic || {}; window.formcraftLogic[3] = [[[[\"field82\",\"equal_to\",\"No\"]],[[\"show_fields\",\"field83\"]],\"and\"],[[[\"field84\",\"equal_to\",\"No\"]],[[\"show_fields\",\"field85\"]],\"and\"],[[[\"field86\",\"equal_to\",\"Yes\"]],[[\"show_fields\",\"field87\"]],\"and\"],[[[\"field90\",\"equal_to\",\"Yes\"]],[[\"show_fields\",\"field10,field91,field93\"]],\"and\"],[[[\"field94\",\"equal_to\",\"Yes\"]],[[\"show_fields\",\"field95\"]],\"and\"],[[[\"field97\",\"equal_to\",\"Referral\"]],[[\"show_fields\",\"field98\"]],\"and\"],[[[\"field97\",\"equal_to\",\"Other\"]],[[\"show_fields\",\"field99\"]],\"and\"]]; <\/script><div class=\"fc-pagination-cover fc-pagination-1\">\n\t\t\t\t<div class=\"fc-pagination width-100\">\n\t\t\t\t\t<!-- ngRepeat: page in Builder.FormElements track by $index --><div class=\"pagination-trigger \" data-index=\"0\">\n\t\t\t\t\t\t<span class=\"page-number\"><span >1<\/span><\/span>\n\t\t\t\t\t\t<span class=\"page-name \">Step 1<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div><!-- end ngRepeat: page in Builder.FormElements track by $index -->\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t<style scoped=\"scoped\" >\n\t\t\t@media (max-width : 480px) {\n\t\t\t\t.fc_modal-dialog-3 .fc-pagination-cover .fc-pagination\n\t\t\t\t{\n\t\t\t\t\tbackground-color: white !important;\n\t\t\t\t}\n\t\t\t}\n\t\t\t\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .submit-cover .submit-button,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .fileupload-cover .button-file,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover .button,\n\t\t\t.formcraft-datepicker .ui-datepicker-header,\n\t\t\t.formcraft-datepicker .ui-datepicker-title\n\t\t\t{\n\t\t\t\tbackground: #f36c21;\n\t\t\t\tcolor: #fff;\n\t\t\t}\n\t\t\t.formcraft-datepicker td .ui-state-active,\n\t\t\t.formcraft-datepicker td .ui-state-hover,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .slider-cover .ui-slider-range\n\t\t\t{\n\t\t\t\tbackground: #f36c21;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-header,\n\t\t\t.formcraft-css .fc-form .field-cover>div.full hr\n\t\t\t{\n\t\t\t\tborder-color: #d55f1d;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-prev:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-next:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker select.ui-datepicker-month:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker select.ui-datepicker-year:hover\n\t\t\t{\n\t\t\t\tbackground-color: #d55f1d;\n\t\t\t}\n\t\t\t.formcraft-css .fc-pagination>div.active .page-number,\n\t\t\t.formcraft-css .form-cover-builder .fc-pagination>div:first-child .page-number\n\t\t\t{\n\t\t\t\tbackground-color: #f36c21;\n\t\t\t\tcolor: #fff;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker table.ui-datepicker-calendar th,\n\t\t\t#ui-datepicker-div.formcraft-datepicker table.ui-datepicker-calendar td.ui-datepicker-today a,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .star-cover label,\n\t\t\thtml .formcraft-css .fc-form.label-floating .form-element .field-cover.has-focus>span,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .customText-cover a,\n\t\t\t.formcraft-css .prev-next>div span:hover\n\t\t\t{\n\t\t\t\tcolor: #f36c21;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .customText-cover a:hover\n\t\t\t{\n\t\t\t\tcolor: #d55f1d;\n\t\t\t}\n\t\t\thtml .formcraft-css .fc-form.fc-form-3.label-floating .form-element .field-cover > span\n\t\t\t{\n\t\t\t\tcolor: #666666;\n\t\t\t}\n\t\t\thtml .formcraft-css .fc-form .final-success .final-success-check {\n\t\t\t\tborder: 2px solid #666666;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"text\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"email\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"password\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"tel\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover textarea,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover select,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover .time-fields-cover,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover .awesomplete ul\n\t\t\t{\n\t\t\t\tcolor: #777;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"text\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"password\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"email\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"radio\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"checkbox\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"tel\"],\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover select,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover textarea\n\t\t\t{\n\t\t\t\tbackground-color: #fafafa;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"radio\"]:checked,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .field-cover input[type=\"checkbox\"]:checked {\n\t\t\t\tborder-color: #d55f1d;\n\t\t\t\tbackground: #f36c21;\t\t\t\t\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .star-cover label .star\n\t\t\t{\n\t\t\t\ttext-shadow: 0px 1px 0px #d55f1d;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .slider-cover .ui-slider-range\n\t\t\t{\n\t\t\t\tbox-shadow: 0px 1px 1px #d55f1d inset;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .fileupload-cover .button-file\n\t\t\t{\n\t\t\t\tborder-color: #d55f1d;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .form-element-html input[type=\"password\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .form-element-html input[type=\"email\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .form-element-html input[type=\"tel\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .form-element-html input[type=\"text\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .form-element-html textarea:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .form-element-html select:focus\n\t\t\t{\n\t\t\t\tborder-color: #f36c21;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3 .form-element .form-element-html .field-cover .is-read-only:focus {\n\t\t\t\tborder-color: #ccc;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-3\t\t\t{\n\t\t\t\tfont-family: inherit;\n\t\t\t}\n\t\t\t@media (max-width : 480px) {\n\t\t\t\thtml .dedicated-page,\n\t\t\t\thtml .dedicated-page .formcraft-css .fc-pagination > div.active\n\t\t\t\t{\n\t\t\t\t\tbackground: white;\n\t\t\t\t}\n\t\t\t}\n\t\t<\/style>\n\t\t<div class=\"form-cover\">\n\t\t\t<form data-auto-scroll=\"\" data-no-message-redirect=\"\" data-thousand=\"\" data-decimal=\".\" data-delay=\"\" data-id=\"3\" class=\"fc-form fc-form-3 align- fc-temp-class save-form- dont-submit-hidden- remove-asterisk- icons-hide- disable-enter- label-inline field-border-visible frame-visible field-alignment-left  \" style=\"width: 100%; color: #666666; font-size: 100%; background: white\">\n\t\t\t\t<!-- ngRepeat: page in Builder.FormElements track by $index --><div class=\"form-page form-page-0\" data-index=\"0\">\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"form-page-content      ng-not-empty\">\n\t\t\t\t\t\t<div data-identifier=\"field101\" data-index=\"0\" style=\"width: 100%\" class=\" form-element form-element-field101 options-false form-element-0 default-false form-element-type-customText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"absolute-false customText-cover field-cover\" style=\"left: ; top: ;right: ;bottom: ;color: #666666 !important; background-color:\"><div class=\"full\" style=\"text-align: left\"><p >Employment Solutions Inc. is an Equal Opportunity Educational Institution and EEO\/Affirmative Action Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.<\/p><p >Complete the entire application. You may attach a resume, but you must still complete all questions; or your application will be deemed incomplete and may not be considered. Please fill out each box (don't just indicate \u201cSee Resume.\u201d) Applications with missing or invalid job numbers will not be considered for any position.<br><\/p><\/div><input type=\"hidden\" name=\"field101\" data-field-id=\"field101\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field12\" data-index=\"1\" style=\"width: 100%\" class=\" even form-element form-element-field12 options-false form-element-1 default-false form-element-type-heading is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 1.6em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >Personal Information<\/span><\/div><input type=\"hidden\" data-field-id=\"field12\" name=\"field12[]\" value=\"Personal Information\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field81\" data-index=\"2\" style=\"width: 100%\" class=\" form-element form-element-field81 options-false form-element-2 default-false form-element-type-checkbox is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Position Applying For:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field81\" type=\"checkbox\" data-is-required=\"false\" name=\"field81[]\" value=\"FHP\" class=\"validation-lenient\"><span><span >FHP<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field81\" type=\"checkbox\" data-is-required=\"false\" name=\"field81[]\" value=\"ADT\" class=\"validation-lenient\"><span><span >ADT<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field81\" type=\"checkbox\" data-is-required=\"false\" name=\"field81[]\" value=\"Relief Worker\" class=\"validation-lenient\"><span><span >Relief Worker<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field81\" type=\"checkbox\" data-is-required=\"false\" name=\"field81[]\" value=\"Administrative\" class=\"validation-lenient\"><span><span >Administrative<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field2\" data-index=\"3\" style=\"width: 100%\" class=\" even form-element form-element-field2 options-false form-element-3 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >First Name<\/span><\/span><span class=\"sub-label\"><span >your first name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field2\" name=\"field2[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field67\" data-index=\"4\" style=\"width: 100%\" class=\" form-element form-element-field67 options-false form-element-4 default-false form-element-type-oneLineText is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Last Name<\/span><\/span><span class=\"sub-label\"><span >your last name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field67\" name=\"field67[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field68\" data-index=\"5\" style=\"width: 100%\" class=\" even form-element form-element-field68 options-false form-element-5 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Other Names<\/span><\/span><span class=\"sub-label\"><span >if applicable<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field68\" name=\"field68[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field70\" data-index=\"6\" style=\"width: 100%\" class=\" form-element form-element-field70 options-false form-element-6 default-false form-element-type-datepicker is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Birth Date<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field70\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"true\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"mm\/dd\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field70\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field176\" data-index=\"7\" style=\"width: 100%\" class=\" even form-element form-element-field176 options-true form-element-7 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Phone Number<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field176\" name=\"field176[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-call\">call<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field119\" data-index=\"8\" style=\"width: 100%\" class=\" form-element form-element-field119 options-false form-element-8 default-false form-element-type-oneLineText is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >E-Mail Address<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field119\" name=\"field119[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field69\" data-index=\"9\" style=\"width: 100%\" class=\" even form-element form-element-field69 options-false form-element-9 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Social Security Number<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field69\" name=\"field69[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field6\" data-index=\"10\" style=\"width: 100%\" class=\" form-element form-element-field6 options-false form-element-10 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >Current Address<\/span><\/div><input type=\"hidden\" data-field-id=\"field6\" name=\"field6[]\" value=\"Current Address\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field3\" data-index=\"11\" style=\"width: 100%\" class=\" even form-element form-element-field3 options-false form-element-11 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Address<\/span><\/span><span class=\"sub-label\"><span >your street address<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field3\" name=\"field3[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field4\" data-index=\"12\" style=\"width: 100%\" class=\" form-element form-element-field4 options-false form-element-12 default-false form-element-type-oneLineText is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >City<\/span><\/span><span class=\"sub-label\"><span >your city<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field4\" name=\"field4[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field5\" data-index=\"13\" style=\"width: 100%\" class=\" even form-element form-element-field5 options-false form-element-13 default-false form-element-type-dropdown is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type- \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >State<\/span><\/span><span class=\"sub-label\"><span >your state<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field5\" name=\"field5\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"AL\" class=\" \">Alabama<\/option><option value=\"AK\" class=\" \">Alaska<\/option><option value=\"AZ\" class=\" \">Arizona<\/option><option value=\"AR\" class=\" \">Arkansas<\/option><option value=\"CA\" class=\" \">California<\/option><option value=\"CO\" class=\" \">Colorado<\/option><option value=\"CT\" class=\" \">Connecticut<\/option><option value=\"DE\" class=\" \">Delaware<\/option><option value=\"FL\" class=\" \">Florida<\/option><option value=\"GA\" class=\" \">Georgia<\/option><option value=\"HI\" class=\" \">Hawaii<\/option><option value=\"ID\" class=\" \">Idaho<\/option><option value=\"IL\" class=\" \">Illinois<\/option><option value=\"IN\" class=\" \">Indiana<\/option><option value=\"IA\" class=\" \">Iowa<\/option><option value=\"KS\" class=\" \">Kansas<\/option><option value=\"KY\" class=\" \">Kentucky<\/option><option value=\"LA\" class=\" \">Louisiana<\/option><option value=\"ME\" class=\" \">Maine<\/option><option value=\"MD\" class=\" \">Maryland<\/option><option value=\"MA\" class=\" \">Massachusetts<\/option><option value=\"MI\" class=\" \">Michigan<\/option><option value=\"MN\" class=\" \">Minnesota<\/option><option value=\"MS\" class=\" \">Mississippi<\/option><option value=\"MO\" class=\" \">Missouri<\/option><option value=\"MT\" class=\" \">Montana<\/option><option value=\"NE\" class=\" \">Nebraska<\/option><option value=\"NV\" class=\" \">Nevada<\/option><option value=\"NH\" class=\" \">New Hampshire<\/option><option value=\"NJ\" class=\" \">New Jersey<\/option><option value=\"NM\" class=\" \">New Mexico<\/option><option value=\"NY\" class=\" \">New York<\/option><option value=\"NC\" class=\" \">North Carolina<\/option><option value=\"ND\" class=\" \">North Dakota<\/option><option value=\"OH\" class=\" \">Ohio<\/option><option value=\"OK\" class=\" \">Oklahoma<\/option><option value=\"OR\" class=\" \">Oregon<\/option><option value=\"PA\" class=\" \">Pennsylvania<\/option><option value=\"RI\" class=\" \">Rhode Island<\/option><option value=\"SC\" class=\" \">South Carolina<\/option><option value=\"SD\" class=\" \">South Dakota<\/option><option value=\"TN\" class=\" \">Tennessee<\/option><option value=\"TX\" class=\" \">Texas<\/option><option value=\"UT\" class=\" \">Utah<\/option><option value=\"VT\" class=\" \">Vermont<\/option><option value=\"VA\" class=\" \">Virginia<\/option><option value=\"WA\" class=\" \">Washington<\/option><option value=\"WV\" class=\" \">West Virginia<\/option><option value=\"WI\" class=\" \">Wisconsin<\/option><option value=\"WY\" class=\" \">Wyoming<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field71\" data-index=\"14\" style=\"width: 100%\" class=\" form-element form-element-field71 options-false form-element-14 default-false form-element-type-oneLineText is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Zip Code<\/span><\/span><span class=\"sub-label\"><span >your zip code<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field71\" name=\"field71[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"numbers\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field82\" data-index=\"15\" style=\"width: 100%\" class=\" even form-element form-element-field82 options-false form-element-15 default-false form-element-type-checkbox is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Are you eligible to work in the United States?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field82\" type=\"radio\" data-is-required=\"true\" name=\"field82[]\" value=\"Yes\" class=\"validation-lenient\"><span><span >Yes<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field82\" type=\"radio\" data-is-required=\"true\" name=\"field82[]\" value=\"No\" class=\"validation-lenient\"><span><span >No<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field83\" data-index=\"16\" style=\"width: 100%\" class=\" form-element form-element-field83 options-false form-element-16 default-true form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Please explain why?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field83\" name=\"field83[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field84\" data-index=\"17\" style=\"width: 100%\" class=\" even form-element form-element-field84 options-false form-element-17 default-false form-element-type-checkbox is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Are you 18 years of age or older?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field84\" type=\"radio\" data-is-required=\"true\" name=\"field84[]\" value=\"Yes\" class=\"validation-lenient\"><span><span >Yes<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field84\" type=\"radio\" data-is-required=\"true\" name=\"field84[]\" value=\"No\" class=\"validation-lenient\"><span><span >No<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field85\" data-index=\"18\" style=\"width: 100%\" class=\" form-element form-element-field85 options-false form-element-18 default-true form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >What is your current age?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field85\" name=\"field85[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field86\" data-index=\"19\" style=\"width: 100%\" class=\" even form-element form-element-field86 options-false form-element-19 default-false form-element-type-checkbox is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Have you ever been employed by Employment Solutions Inc. or Metro?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field86\" type=\"radio\" data-is-required=\"true\" name=\"field86[]\" value=\"Yes\" class=\"validation-lenient\"><span><span >Yes<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field86\" type=\"radio\" data-is-required=\"true\" name=\"field86[]\" value=\"No\" class=\"validation-lenient\"><span><span >No<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field87\" data-index=\"20\" style=\"width: 100%\" class=\" form-element form-element-field87 options-false form-element-20 default-true form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >What is your current job title &amp; department?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field87\" name=\"field87[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field88\" data-index=\"21\" style=\"width: 100%\" class=\" even form-element form-element-field88 options-false form-element-21 default-false form-element-type-checkbox is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Are you related to any current staff member?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field88\" type=\"radio\" data-is-required=\"true\" name=\"field88[]\" value=\"Yes\" class=\"validation-lenient\"><span><span >Yes<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field88\" type=\"radio\" data-is-required=\"true\" name=\"field88[]\" value=\"No\" class=\"validation-lenient\"><span><span >No<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field89\" data-index=\"22\" style=\"width: 100%\" class=\" form-element form-element-field89 options-false form-element-22 default-true form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >What is their name &amp; their relationship to you?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field89\" name=\"field89[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field90\" data-index=\"23\" style=\"width: 100%\" class=\" even form-element form-element-field90 options-false form-element-23 default-false form-element-type-checkbox is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Do you have a valid driver\u2019s license?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field90\" type=\"radio\" data-is-required=\"true\" name=\"field90[]\" value=\"Yes\" class=\"validation-lenient\"><span><span >Yes<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field90\" type=\"radio\" data-is-required=\"true\" name=\"field90[]\" value=\"No\" class=\"validation-lenient\"><span><span >No<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field10\" data-index=\"24\" style=\"width: 25%\" class=\" form-element form-element-field10 options-false form-element-24 default-true form-element-type-dropdown is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type- \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Licensed State<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"false\" class=\"validation-lenient\" data-field-id=\"field10\" name=\"field10\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"AL\" class=\" \">Alabama<\/option><option value=\"AK\" class=\" \">Alaska<\/option><option value=\"AZ\" class=\" \">Arizona<\/option><option value=\"AR\" class=\" \">Arkansas<\/option><option value=\"CA\" class=\" \">California<\/option><option value=\"CO\" class=\" \">Colorado<\/option><option value=\"CT\" class=\" \">Connecticut<\/option><option value=\"DE\" class=\" \">Delaware<\/option><option value=\"FL\" class=\" \">Florida<\/option><option value=\"GA\" class=\" \">Georgia<\/option><option value=\"HI\" class=\" \">Hawaii<\/option><option value=\"ID\" class=\" \">Idaho<\/option><option value=\"IL\" class=\" \">Illinois<\/option><option value=\"IN\" class=\" \">Indiana<\/option><option value=\"IA\" class=\" \">Iowa<\/option><option value=\"KS\" class=\" \">Kansas<\/option><option value=\"KY\" class=\" \">Kentucky<\/option><option value=\"LA\" class=\" \">Louisiana<\/option><option value=\"ME\" class=\" \">Maine<\/option><option value=\"MD\" class=\" \">Maryland<\/option><option value=\"MA\" class=\" \">Massachusetts<\/option><option value=\"MI\" class=\" \">Michigan<\/option><option value=\"MN\" class=\" \">Minnesota<\/option><option value=\"MS\" class=\" \">Mississippi<\/option><option value=\"MO\" class=\" \">Missouri<\/option><option value=\"MT\" class=\" \">Montana<\/option><option value=\"NE\" class=\" \">Nebraska<\/option><option value=\"NV\" class=\" \">Nevada<\/option><option value=\"NH\" class=\" \">New Hampshire<\/option><option value=\"NJ\" class=\" \">New Jersey<\/option><option value=\"NM\" class=\" \">New Mexico<\/option><option value=\"NY\" class=\" \">New York<\/option><option value=\"NC\" class=\" \">North Carolina<\/option><option value=\"ND\" class=\" \">North Dakota<\/option><option value=\"OH\" class=\" \">Ohio<\/option><option value=\"OK\" class=\" \">Oklahoma<\/option><option value=\"OR\" class=\" \">Oregon<\/option><option value=\"PA\" class=\" \">Pennsylvania<\/option><option value=\"RI\" class=\" \">Rhode Island<\/option><option value=\"SC\" class=\" \">South Carolina<\/option><option value=\"SD\" class=\" \">South Dakota<\/option><option value=\"TN\" class=\" \">Tennessee<\/option><option value=\"TX\" class=\" \">Texas<\/option><option value=\"UT\" class=\" \">Utah<\/option><option value=\"VT\" class=\" \">Vermont<\/option><option value=\"VA\" class=\" \">Virginia<\/option><option value=\"WA\" class=\" \">Washington<\/option><option value=\"WV\" class=\" \">West Virginia<\/option><option value=\"WI\" class=\" \">Wisconsin<\/option><option value=\"WY\" class=\" \">Wyoming<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field91\" data-index=\"25\" style=\"width: 50%\" class=\" even form-element form-element-field91 options-false form-element-25 default-true form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >License #<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field91\" name=\"field91[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field93\" data-index=\"26\" style=\"width: 25%\" class=\" form-element form-element-field93 options-false form-element-26 default-true form-element-type-datepicker is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Expiration Date<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field93\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field93\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field94\" data-index=\"27\" style=\"width: 100%\" class=\" even form-element form-element-field94 options-false form-element-27 default-false form-element-type-checkbox is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Have you lived in or worked in another state in the 12 months prior to applying for this position?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field94\" type=\"radio\" data-is-required=\"true\" name=\"field94[]\" value=\"Yes\" class=\"validation-lenient\"><span><span >Yes<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field94\" type=\"radio\" data-is-required=\"true\" name=\"field94[]\" value=\"No\" class=\"validation-lenient\"><span><span >No<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field95\" data-index=\"28\" style=\"width: 100%\" class=\" form-element form-element-field95 options-false form-element-28 default-true form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Please list all states to the right:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field95\" name=\"field95[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field97\" data-index=\"29\" style=\"width: 100%\" class=\" even form-element form-element-field97 options-false form-element-29 default-false form-element-type-checkbox is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >How did you learn about this employment opportunity at Employment Solutions Inc.?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field97\" type=\"radio\" data-is-required=\"true\" name=\"field97[]\" value=\"Ad in newspaper \" class=\"validation-lenient\"><span><span >Ad in newspaper <\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field97\" type=\"radio\" data-is-required=\"true\" name=\"field97[]\" value=\"Job Bulletin (Posting) \/Walk-in\/Website \" class=\"validation-lenient\"><span><span >Job Bulletin (Posting) \/Walk-in\/Website <\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field97\" type=\"radio\" data-is-required=\"true\" name=\"field97[]\" value=\"Dept. of Labor \" class=\"validation-lenient\"><span><span >Dept. of Labor <\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field97\" type=\"radio\" data-is-required=\"true\" name=\"field97[]\" value=\"Referral\" class=\"validation-lenient\"><span><span >Referral<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field97\" type=\"radio\" data-is-required=\"true\" name=\"field97[]\" value=\"Other\" class=\"validation-lenient\"><span><span >Other<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field98\" data-index=\"30\" style=\"width: 50%\" class=\" form-element form-element-field98 options-false form-element-30 default-true form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Referral Name<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field98\" name=\"field98[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field99\" data-index=\"31\" style=\"width: 50%\" class=\" even form-element form-element-field99 options-false form-element-31 default-true form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Other<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field99\" name=\"field99[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field103\" data-index=\"32\" style=\"width: 100%\" class=\" form-element form-element-field103 options-false form-element-32 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 1.7000000000000002em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >Education<\/span><\/div><input type=\"hidden\" data-field-id=\"field103\" name=\"field103[]\" value=\"Education\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field7\" data-index=\"33\" style=\"width: 100%\" class=\" even form-element form-element-field7 options-false form-element-33 default-false form-element-type-heading is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >High School<\/span><\/div><input type=\"hidden\" data-field-id=\"field7\" name=\"field7[]\" value=\"High School\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field8\" data-index=\"34\" style=\"width: 100%\" class=\" form-element form-element-field8 options-false form-element-34 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >High School Name<\/span><\/span><span class=\"sub-label\"><span >write GED is obtained<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field8\" name=\"field8[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field9\" data-index=\"35\" style=\"width: 100%\" class=\" even form-element form-element-field9 options-false form-element-35 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >City<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field9\" name=\"field9[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field23\" data-index=\"36\" style=\"width: 100%\" class=\" form-element form-element-field23 options-false form-element-36 default-false form-element-type-dropdown is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type- \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >State<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"false\" class=\"validation-lenient\" data-field-id=\"field23\" name=\"field23\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"AL\" class=\" \">Alabama<\/option><option value=\"AK\" class=\" \">Alaska<\/option><option value=\"AZ\" class=\" \">Arizona<\/option><option value=\"AR\" class=\" \">Arkansas<\/option><option value=\"CA\" class=\" \">California<\/option><option value=\"CO\" class=\" \">Colorado<\/option><option value=\"CT\" class=\" \">Connecticut<\/option><option value=\"DE\" class=\" \">Delaware<\/option><option value=\"FL\" class=\" \">Florida<\/option><option value=\"GA\" class=\" \">Georgia<\/option><option value=\"HI\" class=\" \">Hawaii<\/option><option value=\"ID\" class=\" \">Idaho<\/option><option value=\"IL\" class=\" \">Illinois<\/option><option value=\"IN\" class=\" \">Indiana<\/option><option value=\"IA\" class=\" \">Iowa<\/option><option value=\"KS\" class=\" \">Kansas<\/option><option value=\"KY\" class=\" \">Kentucky<\/option><option value=\"LA\" class=\" \">Louisiana<\/option><option value=\"ME\" class=\" \">Maine<\/option><option value=\"MD\" class=\" \">Maryland<\/option><option value=\"MA\" class=\" \">Massachusetts<\/option><option value=\"MI\" class=\" \">Michigan<\/option><option value=\"MN\" class=\" \">Minnesota<\/option><option value=\"MS\" class=\" \">Mississippi<\/option><option value=\"MO\" class=\" \">Missouri<\/option><option value=\"MT\" class=\" \">Montana<\/option><option value=\"NE\" class=\" \">Nebraska<\/option><option value=\"NV\" class=\" \">Nevada<\/option><option value=\"NH\" class=\" \">New Hampshire<\/option><option value=\"NJ\" class=\" \">New Jersey<\/option><option value=\"NM\" class=\" \">New Mexico<\/option><option value=\"NY\" class=\" \">New York<\/option><option value=\"NC\" class=\" \">North Carolina<\/option><option value=\"ND\" class=\" \">North Dakota<\/option><option value=\"OH\" class=\" \">Ohio<\/option><option value=\"OK\" class=\" \">Oklahoma<\/option><option value=\"OR\" class=\" \">Oregon<\/option><option value=\"PA\" class=\" \">Pennsylvania<\/option><option value=\"RI\" class=\" \">Rhode Island<\/option><option value=\"SC\" class=\" \">South Carolina<\/option><option value=\"SD\" class=\" \">South Dakota<\/option><option value=\"TN\" class=\" \">Tennessee<\/option><option value=\"TX\" class=\" \">Texas<\/option><option value=\"UT\" class=\" \">Utah<\/option><option value=\"VT\" class=\" \">Vermont<\/option><option value=\"VA\" class=\" \">Virginia<\/option><option value=\"WA\" class=\" \">Washington<\/option><option value=\"WV\" class=\" \">West Virginia<\/option><option value=\"WI\" class=\" \">Wisconsin<\/option><option value=\"WY\" class=\" \">Wyoming<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field104\" data-index=\"37\" style=\"width: 100%\" class=\" even form-element form-element-field104 options-false form-element-37 default-false form-element-type-checkbox is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Did you graduate?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field104\" type=\"radio\" data-is-required=\"false\" name=\"field104[]\" value=\"Yes\" class=\"validation-lenient\"><span><span >Yes<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field104\" type=\"radio\" data-is-required=\"false\" name=\"field104[]\" value=\"No\" class=\"validation-lenient\"><span><span >No<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field72\" data-index=\"38\" style=\"width: 100%\" class=\" form-element form-element-field72 options-false form-element-38 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >If No, # of years remaining<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field72\" name=\"field72[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"numbers\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field11\" data-index=\"39\" style=\"width: 100%\" class=\" even form-element form-element-field11 options-false form-element-39 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Degree Received<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field11\" name=\"field11[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field14\" data-index=\"40\" style=\"width: 100%\" class=\" form-element form-element-field14 options-false form-element-40 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Major<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field14\" name=\"field14[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field106\" data-index=\"41\" style=\"width: 100%\" class=\" even form-element form-element-field106 options-false form-element-41 default-false form-element-type-heading is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >College<\/span><\/div><input type=\"hidden\" data-field-id=\"field106\" name=\"field106[]\" value=\"College\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field107\" data-index=\"42\" style=\"width: 100%\" class=\" form-element form-element-field107 options-false form-element-42 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >College Name<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field107\" name=\"field107[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field108\" data-index=\"43\" style=\"width: 100%\" class=\" even form-element form-element-field108 options-false form-element-43 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >City<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field108\" name=\"field108[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field109\" data-index=\"44\" style=\"width: 100%\" class=\" form-element form-element-field109 options-false form-element-44 default-false form-element-type-dropdown is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type- \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >State<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"false\" class=\"validation-lenient\" data-field-id=\"field109\" name=\"field109\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"AL\" class=\" \">Alabama<\/option><option value=\"AK\" class=\" \">Alaska<\/option><option value=\"AZ\" class=\" \">Arizona<\/option><option value=\"AR\" class=\" \">Arkansas<\/option><option value=\"CA\" class=\" \">California<\/option><option value=\"CO\" class=\" \">Colorado<\/option><option value=\"CT\" class=\" \">Connecticut<\/option><option value=\"DE\" class=\" \">Delaware<\/option><option value=\"FL\" class=\" \">Florida<\/option><option value=\"GA\" class=\" \">Georgia<\/option><option value=\"HI\" class=\" \">Hawaii<\/option><option value=\"ID\" class=\" \">Idaho<\/option><option value=\"IL\" class=\" \">Illinois<\/option><option value=\"IN\" class=\" \">Indiana<\/option><option value=\"IA\" class=\" \">Iowa<\/option><option value=\"KS\" class=\" \">Kansas<\/option><option value=\"KY\" class=\" \">Kentucky<\/option><option value=\"LA\" class=\" \">Louisiana<\/option><option value=\"ME\" class=\" \">Maine<\/option><option value=\"MD\" class=\" \">Maryland<\/option><option value=\"MA\" class=\" \">Massachusetts<\/option><option value=\"MI\" class=\" \">Michigan<\/option><option value=\"MN\" class=\" \">Minnesota<\/option><option value=\"MS\" class=\" \">Mississippi<\/option><option value=\"MO\" class=\" \">Missouri<\/option><option value=\"MT\" class=\" \">Montana<\/option><option value=\"NE\" class=\" \">Nebraska<\/option><option value=\"NV\" class=\" \">Nevada<\/option><option value=\"NH\" class=\" \">New Hampshire<\/option><option value=\"NJ\" class=\" \">New Jersey<\/option><option value=\"NM\" class=\" \">New Mexico<\/option><option value=\"NY\" class=\" \">New York<\/option><option value=\"NC\" class=\" \">North Carolina<\/option><option value=\"ND\" class=\" \">North Dakota<\/option><option value=\"OH\" class=\" \">Ohio<\/option><option value=\"OK\" class=\" \">Oklahoma<\/option><option value=\"OR\" class=\" \">Oregon<\/option><option value=\"PA\" class=\" \">Pennsylvania<\/option><option value=\"RI\" class=\" \">Rhode Island<\/option><option value=\"SC\" class=\" \">South Carolina<\/option><option value=\"SD\" class=\" \">South Dakota<\/option><option value=\"TN\" class=\" \">Tennessee<\/option><option value=\"TX\" class=\" \">Texas<\/option><option value=\"UT\" class=\" \">Utah<\/option><option value=\"VT\" class=\" \">Vermont<\/option><option value=\"VA\" class=\" \">Virginia<\/option><option value=\"WA\" class=\" \">Washington<\/option><option value=\"WV\" class=\" \">West Virginia<\/option><option value=\"WI\" class=\" \">Wisconsin<\/option><option value=\"WY\" class=\" \">Wyoming<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field110\" data-index=\"45\" style=\"width: 100%\" class=\" even form-element form-element-field110 options-false form-element-45 default-false form-element-type-checkbox is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Did you graduate?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field110\" type=\"radio\" data-is-required=\"false\" name=\"field110[]\" value=\"Yes\" class=\"validation-lenient\"><span><span >Yes<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field110\" type=\"radio\" data-is-required=\"false\" name=\"field110[]\" value=\"No\" class=\"validation-lenient\"><span><span >No<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field111\" data-index=\"46\" style=\"width: 100%\" class=\" form-element form-element-field111 options-false form-element-46 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >If No, # of years remaining<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field111\" name=\"field111[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"numbers\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field112\" data-index=\"47\" style=\"width: 100%\" class=\" even form-element form-element-field112 options-false form-element-47 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Degree Received<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field112\" name=\"field112[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field113\" data-index=\"48\" style=\"width: 100%\" class=\" form-element form-element-field113 options-false form-element-48 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Major<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field113\" name=\"field113[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field61\" data-index=\"49\" style=\"width: 100%\" class=\" even form-element form-element-field61 options-false form-element-49 default-false form-element-type-textarea is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"textarea-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert):<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><textarea data-field-id=\"field61\" placeholder=\"\" class=\"validation-lenient\" name=\"field61\" value=\"\" rows=\"7\" data-min-char=\"\" data-max-char=\"\" data-is-required=\"false\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\" style=\"min-height: 147.109px\"><\/textarea><div class=\"count-\"><span class=\"current-count\">0<\/span> \/ <span class=\"max-count \"><\/span><\/div><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field31\" data-index=\"50\" style=\"width: 100%\" class=\" form-element form-element-field31 options-false form-element-50 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 1.5em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >Work Experience<\/span><\/div><input type=\"hidden\" data-field-id=\"field31\" name=\"field31[]\" value=\"Work Experience\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field114\" data-index=\"51\" style=\"width: 100%\" class=\" even form-element form-element-field114 options-false form-element-51 default-false form-element-type-customText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"absolute-false customText-cover field-cover\" style=\"left: ; top: ;right: ;bottom: ;color: #666666 !important; background-color:\"><div class=\"full\" style=\"text-align: left\"><p >WORK EXPERIENCE-Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Attach additional sheets if necessary. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment.<br><\/p><p >Include full-time military or volunteer commitments. <b>PLEASE DO NOT<\/b> complete this information with the notation \u201cSee Resume.\u201d<\/p><p ><b>PLEASE NOTE:<\/b> Employment Solutions Inc. reserves the right to contact all current and former employers for reference information.<\/p><p ><b>PLEASE INCLUDE AT LEAST THE PAST 10 YEARS OF EMPLOYMENT (IF APPLICABLE)<\/b><br><\/p><\/div><input type=\"hidden\" name=\"field114\" data-field-id=\"field114\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field36\" data-index=\"52\" style=\"width: 100%\" class=\" form-element form-element-field36 options-false form-element-52 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >Employer #1<\/span><\/div><input type=\"hidden\" data-field-id=\"field36\" name=\"field36[]\" value=\"Employer #1\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field120\" data-index=\"53\" style=\"width: 70%\" class=\" even form-element form-element-field120 options-false form-element-53 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Company Name &amp; Address:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field120\" name=\"field120[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field121\" data-index=\"54\" style=\"width: 15%\" class=\" form-element form-element-field121 options-false form-element-54 default-false form-element-type-datepicker is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Start Date:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field121\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field121\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field122\" data-index=\"55\" style=\"width: 15%\" class=\" even form-element form-element-field122 options-false form-element-55 default-false form-element-type-datepicker is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >End Date<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field122\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field122\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field123\" data-index=\"56\" style=\"width: 100%\" class=\" form-element form-element-field123 options-false form-element-56 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Position<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field123\" name=\"field123[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field124\" data-index=\"57\" style=\"width: 100%\" class=\" even form-element form-element-field124 options-false form-element-57 default-false form-element-type-checkbox is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Type<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field124\" type=\"checkbox\" data-is-required=\"false\" name=\"field124[]\" value=\"Full Time\" class=\"validation-lenient\"><span><span >Full Time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field124\" type=\"checkbox\" data-is-required=\"false\" name=\"field124[]\" value=\"Part-time\" class=\"validation-lenient\"><span><span >Part-time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field124\" type=\"checkbox\" data-is-required=\"false\" name=\"field124[]\" value=\"Independent\" class=\"validation-lenient\"><span><span >Independent<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field124\" type=\"checkbox\" data-is-required=\"false\" name=\"field124[]\" value=\"Contractor\" class=\"validation-lenient\"><span><span >Contractor<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field125\" data-index=\"58\" style=\"width: 100%\" class=\" form-element form-element-field125 options-false form-element-58 default-false form-element-type-checkbox is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Contact Employer:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field125\" type=\"checkbox\" data-is-required=\"false\" name=\"field125[]\" value=\"At any time\" class=\"validation-lenient\"><span><span >At any time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field125\" type=\"checkbox\" data-is-required=\"false\" name=\"field125[]\" value=\"Only if I am offered job\" class=\"validation-lenient\"><span><span >Only if I am offered job<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field125\" type=\"checkbox\" data-is-required=\"false\" name=\"field125[]\" value=\"Not at all\" class=\"validation-lenient\"><span><span >Not at all<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field126\" data-index=\"59\" style=\"width: 100%\" class=\" even form-element form-element-field126 options-false form-element-59 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Supervisor\u2019s Name, Title, Phone:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field126\" name=\"field126[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field127\" data-index=\"60\" style=\"width: 50%\" class=\" form-element form-element-field127 options-false form-element-60 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Starting Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field127\" name=\"field127[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field129\" data-index=\"61\" style=\"width: 50%\" class=\" even form-element form-element-field129 options-false form-element-61 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Ending Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field129\" name=\"field129[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field45\" data-index=\"62\" style=\"width: 100%\" class=\" form-element form-element-field45 options-false form-element-62 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >Employer #2<\/span><\/div><input type=\"hidden\" data-field-id=\"field45\" name=\"field45[]\" value=\"Employer #2\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field130\" data-index=\"63\" style=\"width: 70%\" class=\" even form-element form-element-field130 options-false form-element-63 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Company Name &amp; Address:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field130\" name=\"field130[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field131\" data-index=\"64\" style=\"width: 15%\" class=\" form-element form-element-field131 options-false form-element-64 default-false form-element-type-datepicker is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Start Date:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field131\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field131\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field132\" data-index=\"65\" style=\"width: 15%\" class=\" even form-element form-element-field132 options-false form-element-65 default-false form-element-type-datepicker is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >End Date<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field132\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field132\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field133\" data-index=\"66\" style=\"width: 100%\" class=\" form-element form-element-field133 options-false form-element-66 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Position<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field133\" name=\"field133[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field134\" data-index=\"67\" style=\"width: 100%\" class=\" even form-element form-element-field134 options-false form-element-67 default-false form-element-type-checkbox is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Type<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field134\" type=\"checkbox\" data-is-required=\"false\" name=\"field134[]\" value=\"Full Time\" class=\"validation-lenient\"><span><span >Full Time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field134\" type=\"checkbox\" data-is-required=\"false\" name=\"field134[]\" value=\"Part-time\" class=\"validation-lenient\"><span><span >Part-time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field134\" type=\"checkbox\" data-is-required=\"false\" name=\"field134[]\" value=\"Independent\" class=\"validation-lenient\"><span><span >Independent<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field134\" type=\"checkbox\" data-is-required=\"false\" name=\"field134[]\" value=\"Contractor\" class=\"validation-lenient\"><span><span >Contractor<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field135\" data-index=\"68\" style=\"width: 100%\" class=\" form-element form-element-field135 options-false form-element-68 default-false form-element-type-checkbox is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Contact Employer:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field135\" type=\"checkbox\" data-is-required=\"false\" name=\"field135[]\" value=\"At any time\" class=\"validation-lenient\"><span><span >At any time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field135\" type=\"checkbox\" data-is-required=\"false\" name=\"field135[]\" value=\"Only if I am offered job\" class=\"validation-lenient\"><span><span >Only if I am offered job<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field135\" type=\"checkbox\" data-is-required=\"false\" name=\"field135[]\" value=\"Not at all\" class=\"validation-lenient\"><span><span >Not at all<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field136\" data-index=\"69\" style=\"width: 100%\" class=\" even form-element form-element-field136 options-false form-element-69 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Supervisor\u2019s Name, Title, Phone:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field136\" name=\"field136[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field137\" data-index=\"70\" style=\"width: 50%\" class=\" form-element form-element-field137 options-false form-element-70 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Starting Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field137\" name=\"field137[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field138\" data-index=\"71\" style=\"width: 50%\" class=\" even form-element form-element-field138 options-false form-element-71 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Ending Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field138\" name=\"field138[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field49\" data-index=\"72\" style=\"width: 100%\" class=\" form-element form-element-field49 options-false form-element-72 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >Employer #3<\/span><\/div><input type=\"hidden\" data-field-id=\"field49\" name=\"field49[]\" value=\"Employer #3\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field139\" data-index=\"73\" style=\"width: 70%\" class=\" even form-element form-element-field139 options-false form-element-73 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Company Name &amp; Address:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field139\" name=\"field139[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field140\" data-index=\"74\" style=\"width: 15%\" class=\" form-element form-element-field140 options-false form-element-74 default-false form-element-type-datepicker is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Start Date:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field140\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field140\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field141\" data-index=\"75\" style=\"width: 15%\" class=\" even form-element form-element-field141 options-false form-element-75 default-false form-element-type-datepicker is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >End Date<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field141\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field141\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field142\" data-index=\"76\" style=\"width: 100%\" class=\" form-element form-element-field142 options-false form-element-76 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Position<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field142\" name=\"field142[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field143\" data-index=\"77\" style=\"width: 100%\" class=\" even form-element form-element-field143 options-false form-element-77 default-false form-element-type-checkbox is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Type<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field143\" type=\"checkbox\" data-is-required=\"false\" name=\"field143[]\" value=\"Full Time\" class=\"validation-lenient\"><span><span >Full Time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field143\" type=\"checkbox\" data-is-required=\"false\" name=\"field143[]\" value=\"Part-time\" class=\"validation-lenient\"><span><span >Part-time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field143\" type=\"checkbox\" data-is-required=\"false\" name=\"field143[]\" value=\"Independent\" class=\"validation-lenient\"><span><span >Independent<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field143\" type=\"checkbox\" data-is-required=\"false\" name=\"field143[]\" value=\"Contractor\" class=\"validation-lenient\"><span><span >Contractor<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field144\" data-index=\"78\" style=\"width: 100%\" class=\" form-element form-element-field144 options-false form-element-78 default-false form-element-type-checkbox is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Contact Employer:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field144\" type=\"checkbox\" data-is-required=\"false\" name=\"field144[]\" value=\"At any time\" class=\"validation-lenient\"><span><span >At any time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field144\" type=\"checkbox\" data-is-required=\"false\" name=\"field144[]\" value=\"Only if I am offered job\" class=\"validation-lenient\"><span><span >Only if I am offered job<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field144\" type=\"checkbox\" data-is-required=\"false\" name=\"field144[]\" value=\"Not at all\" class=\"validation-lenient\"><span><span >Not at all<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field145\" data-index=\"79\" style=\"width: 100%\" class=\" even form-element form-element-field145 options-false form-element-79 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Supervisor\u2019s Name, Title, Phone:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field145\" name=\"field145[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field146\" data-index=\"80\" style=\"width: 50%\" class=\" form-element form-element-field146 options-false form-element-80 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Starting Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field146\" name=\"field146[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field147\" data-index=\"81\" style=\"width: 50%\" class=\" even form-element form-element-field147 options-false form-element-81 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Ending Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field147\" name=\"field147[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field52\" data-index=\"82\" style=\"width: 100%\" class=\" form-element form-element-field52 options-false form-element-82 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >Employer #4<\/span><\/div><input type=\"hidden\" data-field-id=\"field52\" name=\"field52[]\" value=\"Employer #4\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field155\" data-index=\"83\" style=\"width: 70%\" class=\" even form-element form-element-field155 options-false form-element-83 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Company Name &amp; Address:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field155\" name=\"field155[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field154\" data-index=\"84\" style=\"width: 15%\" class=\" form-element form-element-field154 options-false form-element-84 default-false form-element-type-datepicker is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Start Date:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field154\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field154\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field156\" data-index=\"85\" style=\"width: 15%\" class=\" even form-element form-element-field156 options-false form-element-85 default-false form-element-type-datepicker is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >End Date<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field156\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field156\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field153\" data-index=\"86\" style=\"width: 100%\" class=\" form-element form-element-field153 options-false form-element-86 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Position<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field153\" name=\"field153[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field152\" data-index=\"87\" style=\"width: 100%\" class=\" even form-element form-element-field152 options-false form-element-87 default-false form-element-type-checkbox is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Type<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field152\" type=\"checkbox\" data-is-required=\"false\" name=\"field152[]\" value=\"Full Time\" class=\"validation-lenient\"><span><span >Full Time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field152\" type=\"checkbox\" data-is-required=\"false\" name=\"field152[]\" value=\"Part-time\" class=\"validation-lenient\"><span><span >Part-time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field152\" type=\"checkbox\" data-is-required=\"false\" name=\"field152[]\" value=\"Independent\" class=\"validation-lenient\"><span><span >Independent<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field152\" type=\"checkbox\" data-is-required=\"false\" name=\"field152[]\" value=\"Contractor\" class=\"validation-lenient\"><span><span >Contractor<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field151\" data-index=\"88\" style=\"width: 100%\" class=\" form-element form-element-field151 options-false form-element-88 default-false form-element-type-checkbox is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Contact Employer:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field151\" type=\"checkbox\" data-is-required=\"false\" name=\"field151[]\" value=\"At any time\" class=\"validation-lenient\"><span><span >At any time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field151\" type=\"checkbox\" data-is-required=\"false\" name=\"field151[]\" value=\"Only if I am offered job\" class=\"validation-lenient\"><span><span >Only if I am offered job<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field151\" type=\"checkbox\" data-is-required=\"false\" name=\"field151[]\" value=\"Not at all\" class=\"validation-lenient\"><span><span >Not at all<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field150\" data-index=\"89\" style=\"width: 100%\" class=\" even form-element form-element-field150 options-false form-element-89 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Supervisor\u2019s Name, Title, Phone:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field150\" name=\"field150[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field149\" data-index=\"90\" style=\"width: 50%\" class=\" form-element form-element-field149 options-false form-element-90 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Starting Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field149\" name=\"field149[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field148\" data-index=\"91\" style=\"width: 50%\" class=\" even form-element form-element-field148 options-false form-element-91 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Ending Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field148\" name=\"field148[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field53\" data-index=\"92\" style=\"width: 100%\" class=\" form-element form-element-field53 options-false form-element-92 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >Employer #5<\/span><\/div><input type=\"hidden\" data-field-id=\"field53\" name=\"field53[]\" value=\"Employer #5\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field157\" data-index=\"93\" style=\"width: 70%\" class=\" even form-element form-element-field157 options-false form-element-93 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Company Name &amp; Address:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field157\" name=\"field157[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field158\" data-index=\"94\" style=\"width: 15%\" class=\" form-element form-element-field158 options-false form-element-94 default-false form-element-type-datepicker is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Start Date:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field158\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field158\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field160\" data-index=\"95\" style=\"width: 15%\" class=\" even form-element form-element-field160 options-false form-element-95 default-false form-element-type-datepicker is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >End Date<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field160\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field160\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field161\" data-index=\"96\" style=\"width: 100%\" class=\" form-element form-element-field161 options-false form-element-96 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Position<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field161\" name=\"field161[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field162\" data-index=\"97\" style=\"width: 100%\" class=\" even form-element form-element-field162 options-false form-element-97 default-false form-element-type-checkbox is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Type<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field162\" type=\"checkbox\" data-is-required=\"false\" name=\"field162[]\" value=\"Full Time\" class=\"validation-lenient\"><span><span >Full Time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field162\" type=\"checkbox\" data-is-required=\"false\" name=\"field162[]\" value=\"Part-time\" class=\"validation-lenient\"><span><span >Part-time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field162\" type=\"checkbox\" data-is-required=\"false\" name=\"field162[]\" value=\"Independent\" class=\"validation-lenient\"><span><span >Independent<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field162\" type=\"checkbox\" data-is-required=\"false\" name=\"field162[]\" value=\"Contractor\" class=\"validation-lenient\"><span><span >Contractor<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field163\" data-index=\"98\" style=\"width: 100%\" class=\" form-element form-element-field163 options-false form-element-98 default-false form-element-type-checkbox is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Contact Employer:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field163\" type=\"checkbox\" data-is-required=\"false\" name=\"field163[]\" value=\"At any time\" class=\"validation-lenient\"><span><span >At any time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field163\" type=\"checkbox\" data-is-required=\"false\" name=\"field163[]\" value=\"Only if I am offered job\" class=\"validation-lenient\"><span><span >Only if I am offered job<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field163\" type=\"checkbox\" data-is-required=\"false\" name=\"field163[]\" value=\"Not at all\" class=\"validation-lenient\"><span><span >Not at all<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field164\" data-index=\"99\" style=\"width: 100%\" class=\" even form-element form-element-field164 options-false form-element-99 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Supervisor\u2019s Name, Title, Phone:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field164\" name=\"field164[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field165\" data-index=\"100\" style=\"width: 50%\" class=\" form-element form-element-field165 options-false form-element-100 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Starting Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field165\" name=\"field165[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field166\" data-index=\"101\" style=\"width: 50%\" class=\" even form-element form-element-field166 options-false form-element-101 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Ending Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field166\" name=\"field166[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field115\" data-index=\"102\" style=\"width: 100%\" class=\" form-element form-element-field115 options-false form-element-102 default-false form-element-type-heading is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >Employer #6<\/span><\/div><input type=\"hidden\" data-field-id=\"field115\" name=\"field115[]\" value=\"Employer #6\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field175\" data-index=\"103\" style=\"width: 70%\" class=\" even form-element form-element-field175 options-false form-element-103 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Company Name &amp; Address:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field175\" name=\"field175[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field174\" data-index=\"104\" style=\"width: 15%\" class=\" form-element form-element-field174 options-false form-element-104 default-false form-element-type-datepicker is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Start Date:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field174\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field174\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field173\" data-index=\"105\" style=\"width: 15%\" class=\" even form-element form-element-field173 options-false form-element-105 default-false form-element-type-datepicker is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"datepicker-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >End Date<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input autocomplete=\"off\" data-field-id=\"field173\" placeholder=\"\" type=\"text\" class=\"validation-lenient   hasDatepicker ng-empty  \" data-is-required=\"false\" datepicker=\"\" data-date-min-range=\"\" data-date-format=\"dd\/mm\/yy\" data-date-days=\"{&quot;0&quot;:true,&quot;1&quot;:true,&quot;2&quot;:true,&quot;3&quot;:true,&quot;4&quot;:true,&quot;5&quot;:true,&quot;6&quot;:true}\" data-date-min=\"\" data-date-min-alt=\"\" data-date-max-alt=\"\" data-date-max=\"\" data-date-lang=\"en\" name=\"field173\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">date_range<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field172\" data-index=\"106\" style=\"width: 100%\" class=\" form-element form-element-field172 options-false form-element-106 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Position<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field172\" name=\"field172[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field171\" data-index=\"107\" style=\"width: 100%\" class=\" even form-element form-element-field171 options-false form-element-107 default-false form-element-type-checkbox is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Type<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field171\" type=\"checkbox\" data-is-required=\"false\" name=\"field171[]\" value=\"Full Time\" class=\"validation-lenient\"><span><span >Full Time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field171\" type=\"checkbox\" data-is-required=\"false\" name=\"field171[]\" value=\"Part-time\" class=\"validation-lenient\"><span><span >Part-time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field171\" type=\"checkbox\" data-is-required=\"false\" name=\"field171[]\" value=\"Independent\" class=\"validation-lenient\"><span><span >Independent<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field171\" type=\"checkbox\" data-is-required=\"false\" name=\"field171[]\" value=\"Contractor\" class=\"validation-lenient\"><span><span >Contractor<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field170\" data-index=\"108\" style=\"width: 100%\" class=\" form-element form-element-field170 options-false form-element-108 default-false form-element-type-checkbox is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Contact Employer:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field170\" type=\"checkbox\" data-is-required=\"false\" name=\"field170[]\" value=\"At any time\" class=\"validation-lenient\"><span><span >At any time<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field170\" type=\"checkbox\" data-is-required=\"false\" name=\"field170[]\" value=\"Only if I am offered job\" class=\"validation-lenient\"><span><span >Only if I am offered job<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field170\" type=\"checkbox\" data-is-required=\"false\" name=\"field170[]\" value=\"Not at all\" class=\"validation-lenient\"><span><span >Not at all<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field169\" data-index=\"109\" style=\"width: 100%\" class=\" even form-element form-element-field169 options-false form-element-109 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Supervisor\u2019s Name, Title, Phone:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field169\" name=\"field169[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field168\" data-index=\"110\" style=\"width: 50%\" class=\" form-element form-element-field168 options-false form-element-110 default-false form-element-type-oneLineText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Starting Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field168\" name=\"field168[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field167\" data-index=\"111\" style=\"width: 50%\" class=\" even form-element form-element-field167 options-false form-element-111 default-false form-element-type-oneLineText is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Ending Pay:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"\" make-read-only=\"false\" data-field-id=\"field167\" name=\"field167[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field118\" data-index=\"112\" style=\"width: 100%\" class=\" form-element form-element-field118 options-false form-element-112 default-false form-element-type-fileupload is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"wide- fileupload-cover field-cover\"><span class=\"sub-label-\"><span class=\"main-label\"><span >Resume Upload<\/span><\/span><span class=\"sub-label\"><span >upload<\/span><\/span><\/span><div><span class=\"error\"><\/span><div class=\"button button-file fileupload-button\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><i class=\"icon-upload-cloud formcraft-icon\">cloud_upload<\/i><span >Upload<\/span><input type=\"file\" data-name-list=\"field118\" name=\"files\" multiple=\"multiple\" data-allow-extensions=\"\" data-min-files=\"\" data-max-files=\"\" data-max-size=\"\"><\/div><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field66\" data-index=\"113\" style=\"width: 100%\" class=\" even form-element form-element-field66 options-false form-element-113 default-false form-element-type-submit is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"align-center wide-true submit-cover field-cover\"><button type=\"submit\" class=\"button submit-button\"><span class=\"text \">Submit Form<\/span><span class=\"spin-cover\"><i style=\"color:\" class=\"loading-icon icon-cog animate-spin\"><\/i><\/span><\/button><\/div><div class=\"submit-response \"><\/div><label ><input type=\"text\" class=\"required_field\" name=\"website\" autocomplete=\"maple-syrup-pot\"><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div><!-- end ngRepeat: page in Builder.FormElements track by $index -->\n\t\t\t<\/form>\n\t\t\t<div class=\"prev-next prev-next-1\" style=\"width: 100%; color: #666666; font-size: 100%; background: white\">\n\t\t\t\t<div>\n\t\t\t\t\t\n\t\t\t\t\t<span class=\"inactive page-prev \"><i class=\"formcraft-icon\">keyboard_arrow_left<\/i>Previous<\/span><\/div>\n\t\t\t\t<div>\n\t\t\t\t\t\n\t\t\t\t\t<span class=\"page-next \">Next<i class=\"formcraft-icon\">keyboard_arrow_right<\/i><\/span><\/div>\n\t\t\t<\/div>\n\t\t<\/div><a class=\"powered-by\" target=\"_blank\" href=\"http:\/\/formcraft-wp.com?source=pb\"\/>FormCraft - WordPress form builder<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Application - Life Works<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lwr.esinc.org\/application\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Application - Life Works\" \/>\n<meta property=\"og:url\" content=\"https:\/\/lwr.esinc.org\/application\/\" \/>\n<meta property=\"og:site_name\" content=\"Life Works\" \/>\n<meta property=\"article:modified_time\" content=\"2022-11-09T21:13:09+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/lwr.esinc.org\/application\/\",\"url\":\"https:\/\/lwr.esinc.org\/application\/\",\"name\":\"Application - Life 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