{"id":37686,"date":"2023-02-27T13:20:17","date_gmt":"2023-02-27T21:20:17","guid":{"rendered":"https:\/\/www.canbyutility.org\/?page_id=37686"},"modified":"2023-02-27T13:20:59","modified_gmt":"2023-02-27T21:20:59","slug":"employment-application","status":"publish","type":"page","link":"https:\/\/www.canbyutility.org\/about-us\/your-canby-utility\/careers\/employment-application\/","title":{"rendered":"Employment Application"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_chrome gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_12' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/wp-json\/wp\/v2\/pages\/37686' data-formid='12' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_12' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_12_102\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_102\">You may also download and print our  <a href=\"https:\/\/www.canbyutility.org\/wp-content\/uploads\/CU-EMPLOYMENT-APPLICATION-01-2024.pdf\" target=\"_blank\">Employment Application (PDF)<\/a>.<\/div><div id=\"field_12_1\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_1\"><label class='gfield_label gform-field-label' for='input_12_1' >Position Applied For<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_12_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_12_2\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_2\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_12_2'>\n                            \n                            <span id='input_12_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_12_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_2.3' id='input_12_2_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            <span id='input_12_2_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_12_2_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                    <input type='text' name='input_2.4' id='input_12_2_4' value=''   aria-required='false'     \/>\n                                                <\/span>\n                            <span id='input_12_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_12_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_2.6' id='input_12_2_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_12_3\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_3\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_3_1_container' >\n                                        <label for='input_12_3_1' id='input_12_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_3.1' id='input_12_3_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_3_2_container' >\n                                        <label for='input_12_3_2' id='input_12_3_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_3.2' id='input_12_3_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_3_3_container' >\n                                    <label for='input_12_3_3' id='input_12_3_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_3.3' id='input_12_3_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_3_4_container' >\n                                        <label for='input_12_3_4' id='input_12_3_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_3.4' id='input_12_3_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' selected='selected'>Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_3_5_container' >\n                                    <label for='input_12_3_5' id='input_12_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_3.5' id='input_12_3_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_12_3_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_81\"  class=\"gfield gfield--type-phone gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_81\"><label class='gfield_label gform-field-label' for='input_12_81' >Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_81' id='input_12_81' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_82\"  class=\"gfield gfield--type-email gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_82\"><label class='gfield_label gform-field-label' for='input_12_82' >Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_82' id='input_12_82' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_12_4\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_4\"><h3 class=\"gsection_title\">General Information<\/h3><\/div><div id=\"field_12_5\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_5\"><label class='gfield_label gform-field-label' for='input_12_5' >How Did You Hear About This Opening?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_12_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_12_6\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_6\"><legend class='gfield_label gform-field-label'  >Are You Legally Eligible For Employment In the USA?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_6'>\n\t\t\t<div class='gchoice gchoice_12_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes'  id='choice_12_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_6_0' id='label_12_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No'  id='choice_12_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_6_1' id='label_12_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_7\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_7\"><legend class='gfield_label gform-field-label'  >Have You Ever Applied For Employment At Canby Utility?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_7'>\n\t\t\t<div class='gchoice gchoice_12_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Yes'  id='choice_12_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_7_0' id='label_12_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='No'  id='choice_12_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_7_1' id='label_12_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_8\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_8\"><legend class='gfield_label gform-field-label'  >Are You Currently Employed?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_8'>\n\t\t\t<div class='gchoice gchoice_12_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Yes'  id='choice_12_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_8_0' id='label_12_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='No'  id='choice_12_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_8_1' id='label_12_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_9\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_9\"><legend class='gfield_label gform-field-label'  >Have You Ever Been Dismissed or Forced to Resign From Any Position?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_9'>\n\t\t\t<div class='gchoice gchoice_12_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Yes'  id='choice_12_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_9_0' id='label_12_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No'  id='choice_12_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_9_1' id='label_12_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_14\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_14\"><legend class='gfield_label gform-field-label'  >Are You Related To Any Person Now Employed At Canby Utility?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_14'>\n\t\t\t<div class='gchoice gchoice_12_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_12_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_14_0' id='label_12_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_12_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_14_1' id='label_12_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_15\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_15\"><label class='gfield_label gform-field-label' for='input_12_15' >Why Do You Want to Work At Canby Utility?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_12_15' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_12_18\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_18\"><h3 class=\"gsection_title\">Education, Training, &amp; Specialized Skills<\/h3><\/div><fieldset id=\"field_12_19\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_19\"><legend class='gfield_label gform-field-label'  >High School Graduate?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_19'>\n\t\t\t<div class='gchoice gchoice_12_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_12_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_19_0' id='label_12_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_12_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_19_1' id='label_12_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_20\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_20\"><legend class='gfield_label gform-field-label'  >GED?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_20'>\n\t\t\t<div class='gchoice gchoice_12_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Yes'  id='choice_12_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_0' id='label_12_20_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='No'  id='choice_12_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_1' id='label_12_20_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_21\"  class=\"gfield gfield--type-list gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_21\"><legend class='gfield_label gform-field-label'  >Name and Location of College, Vocation or Technical Schools and Training Centers (Note Course of Study\/Major &amp; Degree Where Applicable):<\/legend><div class='ginput_container ginput_container_list ginput_list '><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_21_cell1 gform-grid-col' ><input aria-invalid='false'   aria-label='Name and Location of College, Vocation or Technical Schools and Training Centers (Note Course of Study\/Major &amp; Degree Where Applicable):, Row 1' data-aria-label-template='Name and Location of College, Vocation or Technical Schools and Training Centers (Note Course of Study\/Major &amp; Degree Where Applicable):, Row {0}' type='text' name='input_21[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_12_22\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_22\"><label class='gfield_label gform-field-label' for='input_12_22' >List or Describe Any Specialized Training, Apprenticeships, Certifications<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_12_22' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_12_23\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_23\"><label class='gfield_label gform-field-label' for='input_12_23' >Skills\/Experience<\/label><div class='gfield_description' id='gfield_description_12_23'>List any experience with equipment, machinery, tools, office equipment, software programs, or other special skills that show your ability to perform the job for which you are applying.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_23' id='input_12_23' class='textarea medium'  aria-describedby=\"gfield_description_12_23\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_12_24\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_24\"><label class='gfield_label gform-field-label' for='input_12_24' >(Optional) List Any Foreign Language That You Read, Write, or Speak With Proficiency or Fluency<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_12_24' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_25\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_25\"><h3 class=\"gsection_title\">Employment\/Work Experience<\/h3><\/div><div id=\"field_12_26\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_26\"><p>Begin with your current or most recent position. Include any military, volunteer, and intern experience.<\/p><\/div><div id=\"field_12_27\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_27\"><label class='gfield_label gform-field-label' for='input_12_27' >Name of Employer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_12_27' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_12_28\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_28\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Employer&#039;s Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_28' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_28_1_container' >\n                                        <label for='input_12_28_1' id='input_12_28_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_28.1' id='input_12_28_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_28_2_container' >\n                                        <label for='input_12_28_2' id='input_12_28_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_28.2' id='input_12_28_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_28_3_container' >\n                                    <label for='input_12_28_3' id='input_12_28_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_28.3' id='input_12_28_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_28_4_container' >\n                                        <label for='input_12_28_4' id='input_12_28_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_28.4' id='input_12_28_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_28_5_container' >\n                                    <label for='input_12_28_5' id='input_12_28_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_28.5' id='input_12_28_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_28.6' id='input_12_28_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_29\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_29\"><label class='gfield_label gform-field-label' for='input_12_29' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_29' id='input_12_29' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_30\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_30\"><label class='gfield_label gform-field-label' for='input_12_30' >Your Job Title<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_12_30' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_31\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_31\"><label class='gfield_label gform-field-label' for='input_12_31' >Name of Supervisor\/Title<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_12_31' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_32\"  class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_32\"><label class='gfield_label gform-field-label' for='input_12_32' >Supervisor&#039;s Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_32' id='input_12_32' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_61\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_61\"><label class='gfield_label gform-field-label' for='input_12_61' >Employment Timeline<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_12_61'>example: mm\/yy to mm\/yy<\/div><div class='ginput_container ginput_container_text'><input name='input_61' id='input_12_61' type='text' value='' class='large'  aria-describedby=\"gfield_description_12_61\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_35\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_35\"><label class='gfield_label gform-field-label' for='input_12_35' >Reason for Leaving<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_12_35' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_37\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_37\"><label class='gfield_label gform-field-label' for='input_12_37' >Job Duties<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_37' id='input_12_37' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_12_38\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_38\"><legend class='gfield_label gform-field-label'  >May We Contact This Employer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_38'>\n\t\t\t<div class='gchoice gchoice_12_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Yes'  id='choice_12_38_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_38_0' id='label_12_38_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='No'  id='choice_12_38_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_38_1' id='label_12_38_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_55\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_12_55\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label'  >Additional Employment\/Work Experience?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_55'>\n\t\t\t<div class='gchoice gchoice_12_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Yes'  id='choice_12_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_55_0' id='label_12_55_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='No'  id='choice_12_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_55_1' id='label_12_55_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_57\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_57\"><h3 class=\"gsection_title\">Additional Employment\/Work Experience<\/h3><\/div><div id=\"field_12_56\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_56\"><label class='gfield_label gform-field-label' for='input_12_56' >Name of Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_12_56' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_12_58\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_58\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Employer&#039;s Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_58' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_58_1_container' >\n                                        <label for='input_12_58_1' id='input_12_58_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_58.1' id='input_12_58_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_58_2_container' >\n                                        <label for='input_12_58_2' id='input_12_58_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_58.2' id='input_12_58_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_58_3_container' >\n                                    <label for='input_12_58_3' id='input_12_58_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_58.3' id='input_12_58_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_58_4_container' >\n                                        <label for='input_12_58_4' id='input_12_58_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_58.4' id='input_12_58_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_58_5_container' >\n                                    <label for='input_12_58_5' id='input_12_58_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_58.5' id='input_12_58_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_58.6' id='input_12_58_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_59\"  class=\"gfield gfield--type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_59\"><label class='gfield_label gform-field-label' for='input_12_59' >Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_59' id='input_12_59' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_60\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_60\"><label class='gfield_label gform-field-label' for='input_12_60' >Your Job Title<\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_12_60' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_62\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_62\"><label class='gfield_label gform-field-label' for='input_12_62' >Name of Supervisor\/Title<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_12_62' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_63\"  class=\"gfield gfield--type-phone gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_63\"><label class='gfield_label gform-field-label' for='input_12_63' >Supervisor&#039;s Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_63' id='input_12_63' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_64\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_64\"><label class='gfield_label gform-field-label' for='input_12_64' >Employment Timeline<\/label><div class='gfield_description' id='gfield_description_12_64'>example: mm\/yy to mm\/yy<\/div><div class='ginput_container ginput_container_text'><input name='input_64' id='input_12_64' type='text' value='' class='large'  aria-describedby=\"gfield_description_12_64\"    aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_65\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_65\"><label class='gfield_label gform-field-label' for='input_12_65' >Reason for Leaving<\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_12_65' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_66\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_66\"><label class='gfield_label gform-field-label' for='input_12_66' >Job Duties<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_66' id='input_12_66' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_12_67\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_67\"><legend class='gfield_label gform-field-label'  >May We Contact This Employer?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_67'>\n\t\t\t<div class='gchoice gchoice_12_67_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Yes'  id='choice_12_67_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_67_0' id='label_12_67_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_67_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='No'  id='choice_12_67_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_67_1' id='label_12_67_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_79\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_12_79\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label'  >Additional Employment\/Work Experience?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_79'>\n\t\t\t<div class='gchoice gchoice_12_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Yes'  id='choice_12_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_79_0' id='label_12_79_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='No'  id='choice_12_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_79_1' id='label_12_79_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_68\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_68\"><h3 class=\"gsection_title\">Additional Employment\/Work Experience<\/h3><\/div><div id=\"field_12_69\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_69\"><label class='gfield_label gform-field-label' for='input_12_69' >Name of Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_12_69' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_12_70\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_70\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Employer&#039;s Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_70' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_70_1_container' >\n                                        <label for='input_12_70_1' id='input_12_70_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_70.1' id='input_12_70_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_70_2_container' >\n                                        <label for='input_12_70_2' id='input_12_70_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_70.2' id='input_12_70_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_70_3_container' >\n                                    <label for='input_12_70_3' id='input_12_70_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_70.3' id='input_12_70_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_70_4_container' >\n                                        <label for='input_12_70_4' id='input_12_70_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_70.4' id='input_12_70_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_70_5_container' >\n                                    <label for='input_12_70_5' id='input_12_70_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_70.5' id='input_12_70_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_70.6' id='input_12_70_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_71\"  class=\"gfield gfield--type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_71\"><label class='gfield_label gform-field-label' for='input_12_71' >Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_71' id='input_12_71' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_72\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_72\"><label class='gfield_label gform-field-label' for='input_12_72' >Your Job Title<\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_12_72' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_73\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_73\"><label class='gfield_label gform-field-label' for='input_12_73' >Name of Supervisor\/Title<\/label><div class='ginput_container ginput_container_text'><input name='input_73' id='input_12_73' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_74\"  class=\"gfield gfield--type-phone gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_74\"><label class='gfield_label gform-field-label' for='input_12_74' >Supervisor&#039;s Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_74' id='input_12_74' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_75\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_75\"><label class='gfield_label gform-field-label' for='input_12_75' >Employment Timeline<\/label><div class='gfield_description' id='gfield_description_12_75'>example: mm\/yy to mm\/yy<\/div><div class='ginput_container ginput_container_text'><input name='input_75' id='input_12_75' type='text' value='' class='large'  aria-describedby=\"gfield_description_12_75\"    aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_76\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_76\"><label class='gfield_label gform-field-label' for='input_12_76' >Reason for Leaving<\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_12_76' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_77\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_77\"><label class='gfield_label gform-field-label' for='input_12_77' >Job Duties<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_77' id='input_12_77' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_12_78\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_78\"><legend class='gfield_label gform-field-label'  >May We Contact This Employer?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_78'>\n\t\t\t<div class='gchoice gchoice_12_78_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='Yes'  id='choice_12_78_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_78_0' id='label_12_78_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_78_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='No'  id='choice_12_78_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_78_1' id='label_12_78_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_40\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_40\"><h3 class=\"gsection_title\">References<\/h3><\/div><div id=\"field_12_98\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_98\"><h4 style=\"color: #222222; \">Reference #1<\/h4><\/div><div id=\"field_12_41\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_41\"><label class='gfield_label gform-field-label' for='input_12_41' >Reference #1 Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_12_41' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_42\"  class=\"gfield gfield--type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_42\"><label class='gfield_label gform-field-label' for='input_12_42' >Years Known<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_42' id='input_12_42' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_12_43\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_43\"><label class='gfield_label gform-field-label' for='input_12_43' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_43' id='input_12_43' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_12_44\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_44\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_44' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_44_1_container' >\n                                        <label for='input_12_44_1' id='input_12_44_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_44.1' id='input_12_44_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_44_2_container' >\n                                        <label for='input_12_44_2' id='input_12_44_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_44.2' id='input_12_44_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_44_3_container' >\n                                    <label for='input_12_44_3' id='input_12_44_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_44.3' id='input_12_44_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_44_4_container' >\n                                        <label for='input_12_44_4' id='input_12_44_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_44.4' id='input_12_44_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_44_5_container' >\n                                    <label for='input_12_44_5' id='input_12_44_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_44.5' id='input_12_44_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_44.6' id='input_12_44_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_45\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_45\"><label class='gfield_label gform-field-label' for='input_12_45' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_45' id='input_12_45' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_12_99\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_99\"><h4 style=\"color: #222222; \">Reference #2<\/h4><\/div><div id=\"field_12_83\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_83\"><label class='gfield_label gform-field-label' for='input_12_83' >Reference #2 Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_12_83' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_84\"  class=\"gfield gfield--type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_84\"><label class='gfield_label gform-field-label' for='input_12_84' >Years Known<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_84' id='input_12_84' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_12_85\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_85\"><label class='gfield_label gform-field-label' for='input_12_85' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_85' id='input_12_85' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_12_86\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_86\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_86' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_86_1_container' >\n                                        <label for='input_12_86_1' id='input_12_86_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_86.1' id='input_12_86_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_86_2_container' >\n                                        <label for='input_12_86_2' id='input_12_86_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_86.2' id='input_12_86_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_86_3_container' >\n                                    <label for='input_12_86_3' id='input_12_86_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_86.3' id='input_12_86_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_86_4_container' >\n                                        <label for='input_12_86_4' id='input_12_86_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_86.4' id='input_12_86_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_86_5_container' >\n                                    <label for='input_12_86_5' id='input_12_86_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_86.5' id='input_12_86_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_86.6' id='input_12_86_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_87\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_87\"><label class='gfield_label gform-field-label' for='input_12_87' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_87' id='input_12_87' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_12_100\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_100\"><h4 style=\"color: #222222; \">Reference #3<\/h4><\/div><div id=\"field_12_88\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_88\"><label class='gfield_label gform-field-label' for='input_12_88' >Reference #3 Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_12_88' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_89\"  class=\"gfield gfield--type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_89\"><label class='gfield_label gform-field-label' for='input_12_89' >Years Known<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_89' id='input_12_89' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_12_90\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_90\"><label class='gfield_label gform-field-label' for='input_12_90' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_90' id='input_12_90' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_12_91\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_91\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_91' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_91_1_container' >\n                                        <label for='input_12_91_1' id='input_12_91_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_91.1' id='input_12_91_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_91_2_container' >\n                                        <label for='input_12_91_2' id='input_12_91_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_91.2' id='input_12_91_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_91_3_container' >\n                                    <label for='input_12_91_3' id='input_12_91_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_91.3' id='input_12_91_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_91_4_container' >\n                                        <label for='input_12_91_4' id='input_12_91_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_91.4' id='input_12_91_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_91_5_container' >\n                                    <label for='input_12_91_5' id='input_12_91_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_91.5' id='input_12_91_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_91.6' id='input_12_91_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_92\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_92\"><label class='gfield_label gform-field-label' for='input_12_92' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_92' id='input_12_92' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_12_101\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_101\"><h4 style=\"color: #222222; \">Reference #4<\/h4><\/div><div id=\"field_12_93\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_93\"><label class='gfield_label gform-field-label' for='input_12_93' >Reference #4 Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_12_93' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_94\"  class=\"gfield gfield--type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_94\"><label class='gfield_label gform-field-label' for='input_12_94' >Years Known<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_94' id='input_12_94' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_12_95\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_95\"><label class='gfield_label gform-field-label' for='input_12_95' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_95' id='input_12_95' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_12_96\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_96\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_96' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_96_1_container' >\n                                        <label for='input_12_96_1' id='input_12_96_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_96.1' id='input_12_96_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_96_2_container' >\n                                        <label for='input_12_96_2' id='input_12_96_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_96.2' id='input_12_96_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_96_3_container' >\n                                    <label for='input_12_96_3' id='input_12_96_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_96.3' id='input_12_96_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_96_4_container' >\n                                        <label for='input_12_96_4' id='input_12_96_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_96.4' id='input_12_96_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_96_5_container' >\n                                    <label for='input_12_96_5' id='input_12_96_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_96.5' id='input_12_96_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_96.6' id='input_12_96_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_97\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_97\"><label class='gfield_label gform-field-label' for='input_12_97' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_97' id='input_12_97' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_12_46\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_46\"><h3 class=\"gsection_title\">Please Read Carefully &amp; Sign<\/h3><\/div><fieldset id=\"field_12_80\"  class=\"gfield gfield--type-tos gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_80\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Terms of Service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='gw_terms_80' class='large gptos_terms_container gwtos_terms_container' tabindex='0'><div class='gptos_the_terms'><p>I certify that the information contained in this application and all other information otherwise furnished by me shall be true, complete, and correct. I understand that incorrect, incomplete, deliberately omitted, false or misleading statements, answers or information furnished by me either verbally or in writing will subject my application to disqualification from further consideration and\/or if already employed by the Canby Utility Board, when the aforementioned is detected, I will be subject to discipline up to and including discharge, for falsifying a document regardless of how much time has elapsed since the date I was employed.<\/p>\n<p>It is my understanding that the Canby Utility Board may make a thorough investigation of my entire work and personal history and may verify data given in my application (unless otherwise noted) for employment, related papers, or oral interview. I specifically authorize any of the persons or organizations referenced in this application to give you any and all information they may have, personal or otherwise with regard to any subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information. I also understand that I may be asked to submit to a pre-employment drug test, a criminal history background check and credit check as a condition of employment.<\/p>\n<p>If I am offered employment with such offer conditioned upon the successful completion of a physical examination, I agree to undergo said physical examination, which may include but not limited to drug screen, physical abilities\/capabilities testing, x rays, examination, and laboratory tests at the time of such offer of employment, or anytime thereafter, to determine if I am physically fit for the job(s) I am to perform, or to determine if I meet the standards required of the position applied for. In addition, I also expressly authorize any physician, hospital or other institution to release any pertinent medical records or information with respect to my physical status, either concurrent or with subsequent to my employment with Canby Utility, in the event such medical records or information are related to any claim made against the Canby Utility Board.<\/p>\n<p>I understand that this is an application for employment and that no employment contract is being offered or implied. I further understand that if an employment offer is made such offer may be withdrawn with or without prior notice, at any time, at the option of either the Canby Utility Board or me.<\/p>\n<p>This application will remain valid for 90 days from the date I signed. If I want to be considered for additional job openings, I will submit a new application.<\/p>\n<\/div><\/div>\n\t\t<style type=\"text\/css\">\n\n\t\t\t\/* Frontend Styles *\/\n\t\t\t.gptos_terms_container { height: 11.250em; width: 97.5%; background-color: #fff; overflow: auto; border: 1px solid #ccc; }\n\t\t\t.gptos_terms_container.small { width: 25%; }\n\t\t\t.gptos_terms_container.medium { width: 47.5%; }\n\t\t\t.gptos_terms_container.large { \/* default width *\/ }\n\t\t\t.left_label .gptos_terms_container,\n\t\t\t.right_label .gptos_terms_container { margin-left: 30% !important; width: auto !important; }\n\t\t\t.gform_wrapper .gptos_terms_container > div { margin: 1rem !important; }\n\t\t\t.gform_wrapper .gptos_terms_container ul,\n\t\t\t.gform_wrapper .gptos_terms_container ol { margin: 0 0 1rem 1.5rem !important; }\n\t\t\t.gform_wrapper .gptos_terms_container ul li { list-style: disc !important; }\n\t\t\t.gform_wrapper .gptos_terms_container ol li { list-style: decimal !important; }\n\t\t\t.gform_wrapper .gptos_terms_container p { margin: 0 0 1rem; }\n\t\t\t.gform_wrapper .gptos_terms_container *:last-child { margin-bottom: 0; }\n\n\t\t\t.gptos_input_container { margin-top: 12px; }\n\t\t\t.gptos_input_container ul { padding: 0; }\n\n\t\t\t\/* Admin Styles *\/\n\t\t\t#gform_fields .gptos_terms_container { background-color: rgba( 255, 255, 255, 0.5 ); border-color: rgba( 222, 222, 222, 0.75 ); }\n\t\t\t#gform_fields .gptos_terms_container > div { margin: 1rem !important; }\n\t\t\t#gform_fields .gptos_terms_container p { margin: 0 0 1rem; }\n\t\t\t#gform_fields .gptos_terms_container *:last-child { margin-bottom: 0; }\n\n\t\t<\/style>\n\n\t\t<div class=\"ginput_container gptos_input_container\"><div class=\"gfield_checkbox\" id=\"input_12_80\"><div class='gchoice gchoice_12_80_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.1' type='checkbox'  value='I agree to the Terms of Service'  id='choice_12_80_1'  disabled='disabled' \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_80_1' id='label_12_80_1' class='gform-field-label gform-field-label--type-inline'>I agree to the Terms of Service<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_49\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_49\"><label class='gfield_label gform-field-label' for='input_12_49' >Applicant&#039;s Electronic Signature (Full Name)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_12_49' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_50\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_50\"><h3 class=\"gsection_title\">Equal Opportunity Employer<\/h3><\/div><div id=\"field_12_51\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_51\"><p>Canby Utility is an equal employment opportunity employer. We are dedicated to a policy of nondiscrimination in employment on the basis of race, color, religion, sex, national origin, age or mental and or physical disability. The information requested is used for the purpose of maintaining records required by the Federal government and will not be considered in making any employment decision. The completion of this section is <strong>optional<\/strong>.<\/p><\/div><fieldset id=\"field_12_52\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_52\"><legend class='gfield_label gform-field-label'  >Race<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_52'>\n\t\t\t<div class='gchoice gchoice_12_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='White (Not of Hispanic Origin)'  id='choice_12_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_52_0' id='label_12_52_0' class='gform-field-label gform-field-label--type-inline'>White (Not of Hispanic Origin)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Black (Not of Hispanic Origin)'  id='choice_12_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_52_1' id='label_12_52_1' class='gform-field-label gform-field-label--type-inline'>Black (Not of Hispanic Origin)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_52_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Hispanic'  id='choice_12_52_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_52_2' id='label_12_52_2' class='gform-field-label gform-field-label--type-inline'>Hispanic<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_52_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Asian or Pacific Islander'  id='choice_12_52_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_52_3' id='label_12_52_3' class='gform-field-label gform-field-label--type-inline'>Asian or Pacific Islander<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_52_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='American Indian or Alaskan Native'  id='choice_12_52_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_52_4' id='label_12_52_4' class='gform-field-label gform-field-label--type-inline'>American Indian or Alaskan Native<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_53\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_53\"><legend class='gfield_label gform-field-label'  >Sex<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_53'>\n\t\t\t<div class='gchoice gchoice_12_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Male'  id='choice_12_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_53_0' id='label_12_53_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Female'  id='choice_12_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_53_1' id='label_12_53_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_54\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_54\"><p>The information provided in this section will not be used to evaluate your qualifications for employment.<\/p><\/div><div id=\"field_12_103\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_103\"><h3 class=\"gsection_title\">Supplemental Information<\/h3><\/div><fieldset id=\"field_12_10\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_10\"><legend class='gfield_label gform-field-label'  >Do You Have a Valid Driver&#039;s License?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_10'>\n\t\t\t<div class='gchoice gchoice_12_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Yes'  id='choice_12_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_10_0' id='label_12_10_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No'  id='choice_12_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_10_1' id='label_12_10_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_13\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_13\"><label class='gfield_label gform-field-label' for='input_12_13' >State Issued<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_12_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_104\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_104\"><label class='gfield_label gform-field-label' for='input_12_104' >Type of Driver&#039;s License<\/label><div class='ginput_container ginput_container_text'><input name='input_104' id='input_12_104' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_12\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_12\"><label class='gfield_label gform-field-label' for='input_12_12' >Driver&#039;s License Class<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_12_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_12_11\"  class=\"gfield gfield--type-number gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_11\"><label class='gfield_label gform-field-label' for='input_12_11' >Driver&#039;s License Number<\/label><div class='ginput_container ginput_container_number'><input name='input_11' id='input_12_11' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_12_105\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_105\"><label class='gfield_label gform-field-label' for='input_12_105' >Expiration Date<\/label><div class='ginput_container ginput_container_text'><input name='input_105' id='input_12_105' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_12_106\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_12_106\"><legend class='gfield_label gform-field-label'  >CDL Drivers Only: Do you have a current medical card?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_106'>\n\t\t\t<div class='gchoice gchoice_12_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Yes'  id='choice_12_106_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_106_0' id='label_12_106_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='No'  id='choice_12_106_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_106_1' id='label_12_106_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_107\"  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