{"id":107,"date":"2021-08-23T01:18:59","date_gmt":"2021-08-23T01:18:59","guid":{"rendered":"https:\/\/adagehealthsolutions.com\/blog\/?page_id=107"},"modified":"2022-08-22T14:49:30","modified_gmt":"2022-08-22T14:49:30","slug":"apply","status":"publish","type":"page","link":"https:\/\/adagehealthsolutions.com\/care\/apply\/","title":{"rendered":"Apply"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-126\"><form id=\"wpforms-form-126\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"126\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/care\/wp-json\/wp\/v2\/pages\/107?wpforms_form_id=126\" data-token=\"12ea9e957bc17b7266799f026e4bd3a5\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 3<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:33.333333333333%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-126-field_99-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"99\"><\/div><div id=\"wpforms-126-field_90-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"90\"><div id=\"wpforms-126-field_90\"><p>Adage Healthcare Solutions prohibits discrimination on the basis of age, citizenship, race, disability, marital status, national origin, religion, sex, sex orientation, veteran's status or any other characteristic protected by federal state or local law.<\/p><\/div><\/div><div id=\"wpforms-126-field_91-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"91\"><div id=\"wpforms-126-field_91\"><p>Please print clearly and complete all information requested<\/p><\/div><\/div><div id=\"wpforms-126-field_92-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"92\"><\/div><div id=\"wpforms-126-field_8-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_8\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-126-field_8\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][8][first]\" required><label for=\"wpforms-126-field_8\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-126-field_8-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][8][middle]\" ><label for=\"wpforms-126-field_8-middle\" class=\"wpforms-field-sublabel after \">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-126-field_8-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][8][last]\" required><label for=\"wpforms-126-field_8-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-126-field_74-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_74\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-126-field_74\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][74][address1]\" required><label for=\"wpforms-126-field_74\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-126-field_74-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][74][address2]\" ><label for=\"wpforms-126-field_74-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-126-field_74-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][74][city]\" required><label for=\"wpforms-126-field_74-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-126-field_74-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][74][state]\" required><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-126-field_74-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-126-field_74-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][74][postal]\" required><label for=\"wpforms-126-field_74-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-126-field_75-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_75\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-126-field_75\" class=\"wpforms-field-large wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][75]\" required><\/div><div id=\"wpforms-126-field_76-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_76\">Alternate Phone<\/label><input type=\"tel\" id=\"wpforms-126-field_76\" class=\"wpforms-field-large wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][76]\" ><\/div><div id=\"wpforms-126-field_16-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_16\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-126-field_16\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][16][primary]\" spellcheck=\"false\" required><label for=\"wpforms-126-field_16\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-126-field_16-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-126-field_16\" name=\"wpforms[fields][16][secondary]\" spellcheck=\"false\" required><label for=\"wpforms-126-field_16-secondary\" class=\"wpforms-field-sublabel after \">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-126-field_88-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"88\"><\/div><div id=\"wpforms-126-field_17-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-field-select-style-classic\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_17\">Position Desired <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-126-field_17\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][17]\" required=\"required\"><option value=\"What position are your applying for?\" >What position are your applying for?<\/option><option value=\"Registered Nurse\" >Registered Nurse<\/option><option value=\"Physical Therapist\" >Physical Therapist<\/option><option value=\"Occupational Therapist\" >Occupational Therapist<\/option><option value=\"Speech Therapist\" >Speech Therapist<\/option><option value=\"Certified Nursing Assistant\" >Certified Nursing Assistant<\/option><option value=\"Geriatric Nursing Assistant\" >Geriatric Nursing Assistant<\/option><option value=\"Licensed Practical Nurse\" >Licensed Practical Nurse<\/option><option value=\"Medication Technician\" >Medication Technician<\/option><option value=\"Home Health Aide\" >Home Health Aide<\/option><option value=\"Companion\" >Companion<\/option><\/select><\/div><div id=\"wpforms-126-field_18-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-field-select-style-classic\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_18\">Type of Employment <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-126-field_18\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][18]\" required=\"required\"><option value=\"Choose one\" >Choose one<\/option><option value=\"Full Time\" >Full Time<\/option><option value=\"Part Time\" >Part Time<\/option><\/select><\/div><div id=\"wpforms-126-field_19-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"19\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_19\">Salary you expect<\/label><input type=\"text\" id=\"wpforms-126-field_19\" class=\"wpforms-field-large\" name=\"wpforms[fields][19]\" placeholder=\"Salary you expect\" ><\/div><div id=\"wpforms-126-field_77-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"77\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_77\">What date are you available to start working? <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-126-field_77\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][77][date]\" placeholder=\"What date are you available to start working?\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-126-field_21-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_21\">What days are you available to work, Please list days and hours of availability. eg Monday: 9am-5pm<\/label><textarea id=\"wpforms-126-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" ><\/textarea><\/div><div id=\"wpforms-126-field_25-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_25\">Are you available to work additional hours or a different shift based on business needs?<\/label><select id=\"wpforms-126-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\"><option value=\"Choose one\" >Choose one<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-126-field_89-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"89\"><\/div><div id=\"wpforms-126-field_26-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-field-select-style-classic\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_26\">Employment Status <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-126-field_26\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][26]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Are you currently employed?<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-126-field_27-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"27\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_27\">Is it your intent to continue in your current job if you work here? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-126-field_27\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][27]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Is it your intent to continue in your current job if you work here?<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-126-field_98-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"98\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"126\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-126-field_101-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"101\"><div id=\"wpforms-126-field_101\"><p>Please list information about your current or most recent employer. Include military service or self employment. You must account for the past 3 years or the time since you completed school, whichever is shorter. Please provide all information requested even if it is included in your resume. If your earnings from a previous job were commission based or other, please estimate your average weekly earnings.<\/p><\/div><\/div><div id=\"wpforms-126-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_28\">Employment History <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_28\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][28]\" placeholder=\"Current or Last Employer Name\" required><\/div><div id=\"wpforms-126-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_29\">Employer Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_29\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][29]\" placeholder=\"Employer Address\" required><\/div><div id=\"wpforms-126-field_30-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"30\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_30\">Name of Supervisor <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_30\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][30]\" placeholder=\"Name of Supervisor\" required><\/div><div id=\"wpforms-126-field_31-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"31\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_31\"> Ending Salary <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_31\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][31]\" placeholder=\" Ending Salary\" required><\/div><div id=\"wpforms-126-field_32-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"32\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_32\">Job Title <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_32\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][32]\" placeholder=\"Job Title\" required><\/div><div id=\"wpforms-126-field_33-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"33\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_33\">Reason for leaving <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_33\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][33]\" placeholder=\"Reason for leaving\" required><\/div><div id=\"wpforms-126-field_85-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first\" data-field-id=\"85\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_85\">Beginning Date of Employment  <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-126-field_85\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][85][date]\" placeholder=\"Beginning Date of Employment\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-126-field_84-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"84\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_84\">Ending Date of Employment<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-126-field_84\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][84][date]\" placeholder=\"Ending Date of Employment\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-126-field_35-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"35\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_35\">Employer Phone<\/label><input type=\"text\" id=\"wpforms-126-field_35\" class=\"wpforms-field-small\" name=\"wpforms[fields][35]\" placeholder=\"Employer Phone\" ><\/div><div id=\"wpforms-126-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_36\">Employment History 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_36\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][36]\" placeholder=\"Employer Name\" required><\/div><div id=\"wpforms-126-field_37-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"37\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_37\">Employer Address 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_37\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][37]\" placeholder=\"Employer Address\" required><\/div><div id=\"wpforms-126-field_38-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"38\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_38\">Name of Supervisor 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_38\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][38]\" placeholder=\"Name of Supervisor\" required><\/div><div id=\"wpforms-126-field_39-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"39\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_39\"> Ending Salary 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_39\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][39]\" placeholder=\" Ending Salary\" required><\/div><div id=\"wpforms-126-field_40-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"40\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_40\">Job Title 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_40\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][40]\" placeholder=\"Job Title\" required><\/div><div id=\"wpforms-126-field_41-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"41\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_41\">Reason for leaving 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_41\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][41]\" placeholder=\"Reason for leaving\" required><\/div><div id=\"wpforms-126-field_83-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first\" data-field-id=\"83\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_83\">Beginning Date of Employment 2 <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-126-field_83\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][83][date]\" placeholder=\"Beginning Date of Employment\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-126-field_86-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"86\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_86\">Ending Date of Employment 2<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-126-field_86\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][86][date]\" placeholder=\"Ending Date of Employment\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-126-field_43-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"43\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_43\">Employer Phone 2<\/label><input type=\"text\" id=\"wpforms-126-field_43\" class=\"wpforms-field-small\" name=\"wpforms[fields][43]\" placeholder=\"Employer Phone\" ><\/div><div id=\"wpforms-126-field_44-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_44\">Employment History 3 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_44\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][44]\" placeholder=\"Employer Name\" required><\/div><div id=\"wpforms-126-field_45-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"45\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_45\">Employer Address 3 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_45\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][45]\" placeholder=\"Employer Address\" required><\/div><div id=\"wpforms-126-field_46-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"46\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_46\">Name of Supervisor 3 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_46\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][46]\" placeholder=\"Name of Supervisor\" required><\/div><div id=\"wpforms-126-field_47-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"47\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_47\"> Ending Salary 3 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_47\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][47]\" placeholder=\" Ending Salary\" required><\/div><div id=\"wpforms-126-field_48-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"48\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_48\">Job Title 3 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_48\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][48]\" placeholder=\"Job Title\" required><\/div><div id=\"wpforms-126-field_49-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"49\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_49\">Reason for leaving 3 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_49\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][49]\" placeholder=\"Reason for leaving\" required><\/div><div id=\"wpforms-126-field_80-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first\" data-field-id=\"80\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_80\">Beginning Date of Employment 3 <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-126-field_80\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][80][date]\" placeholder=\"Beginning Date of Employment\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-126-field_81-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"81\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_81\">Ending Date of Employment 3<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-126-field_81\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][81][date]\" placeholder=\"Ending Date of Employment\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-126-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"51\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_51\">Employer Phone 3<\/label><input type=\"text\" id=\"wpforms-126-field_51\" class=\"wpforms-field-small\" name=\"wpforms[fields][51]\" placeholder=\"Employer Phone\" ><\/div><div id=\"wpforms-126-field_97-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"97\"><\/div><div id=\"wpforms-126-field_52-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_52\">Education <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_52\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][52]\" placeholder=\"Name of School\/Institution\" required><\/div><div id=\"wpforms-126-field_53-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"53\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_53\">Address of School\/Institution<\/label><input type=\"text\" id=\"wpforms-126-field_53\" class=\"wpforms-field-large\" name=\"wpforms[fields][53]\" placeholder=\"Address of School\/Institution\" ><\/div><div id=\"wpforms-126-field_54-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"54\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_54\">Curriculum or major<\/label><input type=\"text\" id=\"wpforms-126-field_54\" class=\"wpforms-field-large\" name=\"wpforms[fields][54]\" placeholder=\"Curriculum or major\" ><\/div><div id=\"wpforms-126-field_55-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"55\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_55\">Did you graduate<\/label><input type=\"text\" id=\"wpforms-126-field_55\" class=\"wpforms-field-large\" name=\"wpforms[fields][55]\" placeholder=\"Did you graduate\" ><\/div><div id=\"wpforms-126-field_57-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-field-select-style-classic\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_57\">Background Information <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-126-field_57\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][57]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Are you legally able to work in the United States?<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-126-field_59-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"59\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_59\">Can you perform the functions of the job you are applying for <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-126-field_59\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][59]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Can you perform the functions of the job you are applying for?<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-126-field_61-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"61\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_61\">Have you ever been convicted of a crime or violation other than a minor traffic violation? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-126-field_61\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][61]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Have you ever been convicted of a crime or violation other than a minor traffic violation?<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-126-field_102-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"102\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"126\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3 last \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-126-field_62-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_62\">Emergency Contact <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-126-field_62\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][62][first]\" required><label for=\"wpforms-126-field_62\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-126-field_62-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][62][last]\" required><label for=\"wpforms-126-field_62-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-126-field_63-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"63\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_63\">Emergency Contact Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_63\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][63]\" placeholder=\"Emergency Contact Address\" required><\/div><div id=\"wpforms-126-field_64-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"64\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_64\">Emergency Contact Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_64\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][64]\" placeholder=\"Emergency Contact Phone\" required><\/div><div id=\"wpforms-126-field_65-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_65\">References <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-126-field_65\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][65][first]\" required><label for=\"wpforms-126-field_65\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-126-field_65-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][65][last]\" required><label for=\"wpforms-126-field_65-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-126-field_66-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"66\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_66\">References Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_66\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][66]\" placeholder=\"Address\" required><\/div><div id=\"wpforms-126-field_67-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"67\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_67\">Reference Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_67\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][67]\" placeholder=\"Phone\" required><\/div><div id=\"wpforms-126-field_68-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"68\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_68\">Reference Occupation <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_68\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][68]\" placeholder=\"Occupation\" required><\/div><div id=\"wpforms-126-field_69-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_69\">References 2 <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-126-field_69\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][69][first]\" required><label for=\"wpforms-126-field_69\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-126-field_69-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][69][last]\" required><label for=\"wpforms-126-field_69-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-126-field_70-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"70\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_70\">References Address 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" placeholder=\"Address\" required><\/div><div id=\"wpforms-126-field_71-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"71\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_71\">Reference Phone 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_71\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][71]\" placeholder=\"Phone\" required><\/div><div id=\"wpforms-126-field_72-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"72\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-126-field_72\">Reference Occupation 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-126-field_72\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][72]\" placeholder=\"Occupation\" required><\/div><div id=\"wpforms-126-field_103-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_103\">Document Checklist<\/label><ul id=\"wpforms-126-field_103\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_1\" name=\"wpforms[fields][103][]\" value=\"Covid Vaccine Card\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_1\">Covid Vaccine Card<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_2\" name=\"wpforms[fields][103][]\" value=\"Criminal Background Check\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_2\">Criminal Background Check<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_3\" name=\"wpforms[fields][103][]\" value=\"Professional License\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_3\">Professional License<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_4\" name=\"wpforms[fields][103][]\" value=\"Copy of Social Security Card\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_4\">Copy of Social Security Card<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_5\" name=\"wpforms[fields][103][]\" value=\"PPD \/ CHEST X-RAY\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_5\">PPD \/ CHEST X-RAY<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_6\" name=\"wpforms[fields][103][]\" value=\"Tuberculosis (TB)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_6\">Tuberculosis (TB)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_7\" name=\"wpforms[fields][103][]\" value=\"Physical Examination\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_7\">Physical Examination<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_8\" name=\"wpforms[fields][103][]\" value=\"Driver&#039;s License \/ ID Card\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_8\">Driver's License \/ ID Card<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_9\" name=\"wpforms[fields][103][]\" value=\"CPR \/ First Aide\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_9\">CPR \/ First Aide<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-126-field_103_10\" name=\"wpforms[fields][103][]\" value=\"Resume\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-126-field_103_10\">Resume<\/label><\/li><\/ul><\/div><div id=\"wpforms-126-field_78-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-126-field_78\">Upload your Documents Here <span class=\"wpforms-required-label\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"78\"\n\t\tdata-form-id=\"126\"\n\t\tdata-input-name=\"wpforms_126_78\"\n\t\tdata-extensions=\"doc,pdf,png,gif,jpg\"\n\t\tdata-max-size=\"1048576000\"\n\t\tdata-max-file-number=\"10\"\n\t\tdata-post-max-size=\"33554432\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 10 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-126-field_78\"\n\t\tname=\"wpforms_126_78\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-126-field_79-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"79\"><div id=\"wpforms-126-field_79\"><p>I certify that all statements and answers made on this application are true. 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