{"id":2123,"date":"2023-03-21T14:57:35","date_gmt":"2023-03-21T14:57:35","guid":{"rendered":"https:\/\/sutter-yubamvcd.org\/?page_id=2123"},"modified":"2023-03-28T15:56:53","modified_gmt":"2023-03-28T15:56:53","slug":"employment-application","status":"publish","type":"page","link":"https:\/\/sutter-yubamvcd.org\/about-us\/employment-opportunities\/employment-application\/","title":{"rendered":"Employment Application"},"content":{"rendered":"<div class=\"wpforms-container \" id=\"wpforms-2113\"><form id=\"wpforms-form-2113\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2113\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wp-json\/wp\/v2\/pages\/2123?wpforms_form_id=2113\" data-token=\"160173f3a39e89d1b4c02df87fd55a69\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 6<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:16.666666666667%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-2113-field_26-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"26\"><\/div><div id=\"wpforms-2113-field_3-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"3\"><div id=\"wpforms-2113-field_3\" class=\"wpforms-field-large wpforms-field-row\" name=\"wpforms[fields][3]\"><p><strong>Privacy Statement:&nbsp;<\/strong>Unless required by law, subpoena, or other authority, information collected through forms on this website is for the private use of the Sutter-Yuba Mosquito &amp; Vector Control District and its contractors where there is need or responsibility for its review. Sensitive information requested on web forms is encrypted and transmitted in 256 bit SSL. For individuals that are uncomfortable or have concerns about using digital\/electronic forms requiring sensitive information, please <a rel=\"noopener\" target=\"_blank\" href=\"https:\/\/sutter-yubamvcd.org\/contact-information\">contact our office<\/a> to communicate directly or for other alternatives.<\/p>\n<p>Required <span class=\"form-required\">*<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_4\">Your Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2113-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-2113-field_5-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_5\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2113-field_5\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][5]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-2113-field_7-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_7\">Phone<\/label><input type=\"tel\" id=\"wpforms-2113-field_7\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][7]\" ><\/div><div id=\"wpforms-2113-field_8-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_8\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_8\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][8][address1]\" required><label for=\"wpforms-2113-field_8\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_8-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][8][address2]\" ><label for=\"wpforms-2113-field_8-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_8-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][8][city]\" required><label for=\"wpforms-2113-field_8-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2113-field_8-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][8][state]\" required><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2113-field_8-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_8-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][8][postal]\" required><label for=\"wpforms-2113-field_8-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-2113-field_9-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"9\"><div id=\"wpforms-2113-field_9\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][9]\"><h2>Employment Desired<\/h2>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_151-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"151\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_151\">Position applying for <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-2113-field_151\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][151]\" required=\"required\"><option value=\"Summer Entomologist Aide\" >Summer Entomologist Aide<\/option><option value=\"Seasonal Office Assistant\" >Seasonal Office Assistant<\/option><option value=\"Seasonal Mosquito Control Technician\" >Seasonal Mosquito Control Technician<\/option><option value=\"Summer Mosquito Control Aide\" >Summer Mosquito Control Aide<\/option><\/select><\/div><div id=\"wpforms-2113-field_13-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"13\"><h3 id=\"wpforms-2113-field_13\" name=\"wpforms[fields][13]\">Are you applying for<\/h3><\/div><div id=\"wpforms-2113-field_14-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_14\">Permanent full-time work? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_14_1\" name=\"wpforms[fields][14]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_14_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_14_2\" name=\"wpforms[fields][14]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_14_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_15-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_15\">Seasonal Employment? (typically, 5 months from May-Sept) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_15_1\" name=\"wpforms[fields][15]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_15_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_15_2\" name=\"wpforms[fields][15]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_15_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_24-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"24\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_24\">If applying for seasonal\/temporary work, during what period of time will you be available?<\/label><input type=\"text\" id=\"wpforms-2113-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" ><\/div><div id=\"wpforms-2113-field_16-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_16\">Temporary work, e.g., summer employment? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_16\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_16_1\" name=\"wpforms[fields][16]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_16_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_16_2\" name=\"wpforms[fields][16]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_16_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_17\">What days and hours are you available for work? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2113-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" required><div class=\"wpforms-field-description\">Example: Monday - Friday 8am - 5pm<\/div><\/div><div id=\"wpforms-2113-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_18\">Are you available for work on weekends?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_18_1\" name=\"wpforms[fields][18]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_18_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_18_2\" name=\"wpforms[fields][18]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_18_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_19\">Would you be available to work overtime, if necessary <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_19_1\" name=\"wpforms[fields][19]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_19_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_19_2\" name=\"wpforms[fields][19]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_19_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_20-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_20\">If hired, on what date can you start work? <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2113-field_20\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][20][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2113-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_21\">Salary desired <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2113-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" required><\/div><div id=\"wpforms-2113-field_22-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_22\">Have you ever applied to or worked for Sutter-Yuba MVCD before <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_22_1\" name=\"wpforms[fields][22]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_22_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_22_2\" name=\"wpforms[fields][22]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_22_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_23\">If yes, when? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2113-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" required><\/div><div id=\"wpforms-2113-field_25-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"25\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"2113\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-2113-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_28\">Do you have any friends or relatives working for Sutter-Yuba MVCD? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_28_1\" name=\"wpforms[fields][28]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_28_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_28_2\" name=\"wpforms[fields][28]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_28_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_29\">If yes, state name(s) and relationship<\/label><input type=\"text\" id=\"wpforms-2113-field_29\" class=\"wpforms-field-large\" name=\"wpforms[fields][29]\" ><\/div><div id=\"wpforms-2113-field_30-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_30\">Why are you applying for work at Sutter-Yuba MVCD? <\/label><textarea id=\"wpforms-2113-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_31-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_31\">If hired, would you have reliable means of transportation to and from work?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_31\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_31_1\" name=\"wpforms[fields][31]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_31_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_31_2\" name=\"wpforms[fields][31]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_31_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_32-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_32\">Do you have a valid CA Driver&#039;s License <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_32\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_32_1\" name=\"wpforms[fields][32]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_32_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_32_2\" name=\"wpforms[fields][32]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_32_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_33-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_33\">Do you have any restrictions on your driver&#039;s license that would prevent you from performing any job duties in the job announcement  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_33\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_33_1\" name=\"wpforms[fields][33]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_33_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_33_2\" name=\"wpforms[fields][33]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_33_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_34\">If yes, which duties would you be unable to perform<\/label><input type=\"text\" id=\"wpforms-2113-field_34\" class=\"wpforms-field-large\" name=\"wpforms[fields][34]\" ><\/div><div id=\"wpforms-2113-field_35-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_35\">Are you at least 18 years old? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_35\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_35_1\" name=\"wpforms[fields][35]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_35_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_35_2\" name=\"wpforms[fields][35]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_35_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_36-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_36\">If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in the country? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_36\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_36_1\" name=\"wpforms[fields][36]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_36_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_36_2\" name=\"wpforms[fields][36]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_36_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_37-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_37\">Are you able to perform the essential functions of the job for which you are applying without accommodations? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_37\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_37_1\" name=\"wpforms[fields][37]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_37_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_37_2\" name=\"wpforms[fields][37]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_37_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_38-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_38\">If no, describe the functions that cannot be performed.<\/label><textarea id=\"wpforms-2113-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_39-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_39\">Are you able to perform all other duties of the job for which you are applying without accommodations? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_39\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_39_1\" name=\"wpforms[fields][39]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_39_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_39_2\" name=\"wpforms[fields][39]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_39_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_40-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_40\">If no, describe the duties you cannot perform.<\/label><textarea id=\"wpforms-2113-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_41-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"41\"><div id=\"wpforms-2113-field_41\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][41]\"><p><strong>Note: Hire may be subject to passing a criminal background check, physical examination, and to skill and agility tests.<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_42-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"42\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"2113\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-2113-field_43-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"43\"><h3 id=\"wpforms-2113-field_43\" name=\"wpforms[fields][43]\">High School<\/h3><\/div><div id=\"wpforms-2113-field_44-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_44\">High School Name and Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2113-field_44\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][44]\" required><\/div><div id=\"wpforms-2113-field_45-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_45\">Number of Years Completed <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_45\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][45]\" required><\/div><div id=\"wpforms-2113-field_46-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_46\">Did You Graduate <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_46\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_46_1\" name=\"wpforms[fields][46]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_46_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_46_2\" name=\"wpforms[fields][46]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_46_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_47-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_47\">Diploma or GED <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_47\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_47_1\" name=\"wpforms[fields][47]\" value=\"Diploma\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_47_1\">Diploma<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_47_2\" name=\"wpforms[fields][47]\" value=\"GED\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_47_2\">GED<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_48-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"48\"><h3 id=\"wpforms-2113-field_48\" name=\"wpforms[fields][48]\">College\/University<\/h3><\/div><div id=\"wpforms-2113-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_49\">College\/University Name and Address<\/label><input type=\"text\" id=\"wpforms-2113-field_49\" class=\"wpforms-field-large\" name=\"wpforms[fields][49]\" ><\/div><div id=\"wpforms-2113-field_50-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_50\">Number of Years Completed<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_50\" class=\"wpforms-field-small\" name=\"wpforms[fields][50]\" ><\/div><div id=\"wpforms-2113-field_51-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_51\">Did You Graduate<\/label><ul id=\"wpforms-2113-field_51\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_51_1\" name=\"wpforms[fields][51]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_51_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_51_2\" name=\"wpforms[fields][51]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_51_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_52-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_52\">Degree or Diploma<\/label><ul id=\"wpforms-2113-field_52\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_52_1\" name=\"wpforms[fields][52]\" value=\"Degree\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_52_1\">Degree<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_52_2\" name=\"wpforms[fields][52]\" value=\"Diploma\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_52_2\">Diploma<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_53-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"53\"><h3 id=\"wpforms-2113-field_53\" name=\"wpforms[fields][53]\">Vocational\/ Business<\/h3><\/div><div id=\"wpforms-2113-field_54-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_54\">Vocational\/ Business Name and Address<\/label><input type=\"text\" id=\"wpforms-2113-field_54\" class=\"wpforms-field-large\" name=\"wpforms[fields][54]\" ><\/div><div id=\"wpforms-2113-field_55-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_55\">Number of Years Completed<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_55\" class=\"wpforms-field-small\" name=\"wpforms[fields][55]\" ><\/div><div id=\"wpforms-2113-field_56-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_56\">Did You Graduate<\/label><ul id=\"wpforms-2113-field_56\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_56_1\" name=\"wpforms[fields][56]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_56_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_56_2\" name=\"wpforms[fields][56]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_56_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_57-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_57\">Degree or Diploma<\/label><ul id=\"wpforms-2113-field_57\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_57_1\" name=\"wpforms[fields][57]\" value=\"Degree\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_57_1\">Degree<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_57_2\" name=\"wpforms[fields][57]\" value=\"Diploma\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_57_2\">Diploma<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_58-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"58\"><h3 id=\"wpforms-2113-field_58\" name=\"wpforms[fields][58]\">Health Care<\/h3><\/div><div id=\"wpforms-2113-field_59-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_59\">School Name and Address<\/label><input type=\"text\" id=\"wpforms-2113-field_59\" class=\"wpforms-field-large\" name=\"wpforms[fields][59]\" ><\/div><div id=\"wpforms-2113-field_60-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_60\">Number of Years Completed<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_60\" class=\"wpforms-field-small\" name=\"wpforms[fields][60]\" ><\/div><div id=\"wpforms-2113-field_61-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_61\">Did You Graduate<\/label><ul id=\"wpforms-2113-field_61\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_61_1\" name=\"wpforms[fields][61]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_61_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_61_2\" name=\"wpforms[fields][61]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_61_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_62-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_62\">Degree or Diploma<\/label><ul id=\"wpforms-2113-field_62\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_62_1\" name=\"wpforms[fields][62]\" value=\"Degree\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_62_1\">Degree<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_62_2\" name=\"wpforms[fields][62]\" value=\"Diploma\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_62_2\">Diploma<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_63-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_63\">Do you have any other experience, training, qualifications or skills which you feel make you especially suited for work at Sutter-Yuba MVCD? If so, please explain:<\/label><textarea id=\"wpforms-2113-field_63\" class=\"wpforms-field-medium\" name=\"wpforms[fields][63]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_64-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"64\"><h3 id=\"wpforms-2113-field_64\" name=\"wpforms[fields][64]\">Answer the Following Questions if you are Applying for a Permanent Position<\/h3><\/div><div id=\"wpforms-2113-field_65-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_65\">Are you licensed\/certified for the job applied for?<\/label><ul id=\"wpforms-2113-field_65\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_65_1\" name=\"wpforms[fields][65]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_65_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_65_2\" name=\"wpforms[fields][65]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_65_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_66-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_66\">Name of license\/certification<\/label><input type=\"text\" id=\"wpforms-2113-field_66\" class=\"wpforms-field-large\" name=\"wpforms[fields][66]\" ><\/div><div id=\"wpforms-2113-field_69-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_69\">Issuing State<\/label><select id=\"wpforms-2113-field_69\" class=\"wpforms-field-small choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-small\" data-search-enabled=\"1\" name=\"wpforms[fields][69]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Alabama<\/option><option value=\"Alabama\" >Alabama<\/option><option value=\"Alaska\" >Alaska<\/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=\"Florida\" >Florida<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Hawaii\" >Hawaii<\/option><option value=\"Idaho\" >Idaho<\/option><option value=\"IllinoisIndiana\" >IllinoisIndiana<\/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=\"MontanaNebraska\" >MontanaNebraska<\/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=\"Ohio\" >Ohio<\/option><option value=\"Oklahoma\" >Oklahoma<\/option><option value=\"Oregon\" >Oregon<\/option><option value=\"PennsylvaniaRhode Island\" >PennsylvaniaRhode 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=\"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><\/select><\/div><div id=\"wpforms-2113-field_70-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_70\">License\/certification number<\/label><input type=\"text\" id=\"wpforms-2113-field_70\" class=\"wpforms-field-medium\" name=\"wpforms[fields][70]\" ><\/div><div id=\"wpforms-2113-field_71-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_71\">Has your license\/certification ever been revoked or suspended<\/label><ul id=\"wpforms-2113-field_71\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_71_1\" name=\"wpforms[fields][71]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_71_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_71_2\" name=\"wpforms[fields][71]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_71_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_72-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"72\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_72\">If yes, state reason(s), date of revocation or suspension and date of reinstatement.<\/label><textarea id=\"wpforms-2113-field_72\" class=\"wpforms-field-medium\" name=\"wpforms[fields][72]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_74-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"74\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"2113\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-2113-field_75-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"75\"><div id=\"wpforms-2113-field_75\" class=\"wpforms-field-large wpforms-field-row\" name=\"wpforms[fields][75]\"><p><strong>Please give an accurate and complete full-time and part-time employment record for the last ten (10) years. Start with your most recent employer. Include all gaps in employment.<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_76-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"76\"><h3 id=\"wpforms-2113-field_76\" name=\"wpforms[fields][76]\">Employer 1<\/h3><\/div><div id=\"wpforms-2113-field_81-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"81\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_81\">Name of Employer<\/label><input type=\"text\" id=\"wpforms-2113-field_81\" class=\"wpforms-field-large\" name=\"wpforms[fields][81]\" ><\/div><div id=\"wpforms-2113-field_85-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_85\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_85\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][85][address1]\" ><label for=\"wpforms-2113-field_85\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_85-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][85][city]\" ><label for=\"wpforms-2113-field_85-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2113-field_85-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][85][state]\" ><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2113-field_85-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_85-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][85][postal]\" ><label for=\"wpforms-2113-field_85-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-2113-field_89-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_89\">Type of Business<\/label><input type=\"text\" id=\"wpforms-2113-field_89\" class=\"wpforms-field-large\" name=\"wpforms[fields][89]\" ><\/div><div id=\"wpforms-2113-field_93-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"93\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_93\">Telephone Number<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_93\" class=\"wpforms-field-medium\" name=\"wpforms[fields][93]\" ><\/div><div id=\"wpforms-2113-field_98-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"98\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_98\">Supervisors Name<\/label><input type=\"text\" id=\"wpforms-2113-field_98\" class=\"wpforms-field-large\" name=\"wpforms[fields][98]\" ><\/div><div id=\"wpforms-2113-field_102-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"102\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_102\">Your Position and Duties<\/label><input type=\"text\" id=\"wpforms-2113-field_102\" class=\"wpforms-field-large\" name=\"wpforms[fields][102]\" ><\/div><div id=\"wpforms-2113-field_106-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"106\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2113-field_106\">Date of Employment<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2113-field_107-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"107\"><div id=\"wpforms-2113-field_107\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][107]\"><div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_108-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_108\">From<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2113-field_108\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][108][date]\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-2113-field_110-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"110\"><div id=\"wpforms-2113-field_110\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][110]\"><div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_109-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"109\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_109\">To<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2113-field_109\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][109][date]\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-2113-field_111-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"111\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_111\">Reason for Leaving<\/label><textarea id=\"wpforms-2113-field_111\" class=\"wpforms-field-medium\" name=\"wpforms[fields][111]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_78-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"78\"><h3 id=\"wpforms-2113-field_78\" name=\"wpforms[fields][78]\">Employer 2<\/h3><\/div><div id=\"wpforms-2113-field_82-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"82\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_82\">Name of Employer<\/label><input type=\"text\" id=\"wpforms-2113-field_82\" class=\"wpforms-field-large\" name=\"wpforms[fields][82]\" ><\/div><div id=\"wpforms-2113-field_88-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"88\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_88\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_88\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][88][address1]\" ><label for=\"wpforms-2113-field_88\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_88-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][88][city]\" ><label for=\"wpforms-2113-field_88-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2113-field_88-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][88][state]\" ><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2113-field_88-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_88-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][88][postal]\" ><label for=\"wpforms-2113-field_88-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-2113-field_90-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_90\">Type of Business<\/label><input type=\"text\" id=\"wpforms-2113-field_90\" class=\"wpforms-field-large\" name=\"wpforms[fields][90]\" ><\/div><div id=\"wpforms-2113-field_95-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"95\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_95\">Telephone Number<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_95\" class=\"wpforms-field-medium\" name=\"wpforms[fields][95]\" ><\/div><div id=\"wpforms-2113-field_99-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"99\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_99\">Supervisors Name<\/label><input type=\"text\" id=\"wpforms-2113-field_99\" class=\"wpforms-field-large\" name=\"wpforms[fields][99]\" ><\/div><div id=\"wpforms-2113-field_103-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_103\">Your Position and Duties<\/label><input type=\"text\" id=\"wpforms-2113-field_103\" class=\"wpforms-field-large\" name=\"wpforms[fields][103]\" ><\/div><div id=\"wpforms-2113-field_112-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"112\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_112\">Reason for Leaving<\/label><textarea id=\"wpforms-2113-field_112\" class=\"wpforms-field-medium\" name=\"wpforms[fields][112]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_79-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"79\"><h3 id=\"wpforms-2113-field_79\" name=\"wpforms[fields][79]\">Employer 3<\/h3><\/div><div id=\"wpforms-2113-field_83-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_83\">Name of Employer<\/label><input type=\"text\" id=\"wpforms-2113-field_83\" class=\"wpforms-field-large\" name=\"wpforms[fields][83]\" ><\/div><div id=\"wpforms-2113-field_87-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_87\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_87\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][87][address1]\" ><label for=\"wpforms-2113-field_87\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_87-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][87][city]\" ><label for=\"wpforms-2113-field_87-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2113-field_87-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][87][state]\" ><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2113-field_87-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_87-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][87][postal]\" ><label for=\"wpforms-2113-field_87-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-2113-field_91-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_91\">Type of Business<\/label><input type=\"text\" id=\"wpforms-2113-field_91\" class=\"wpforms-field-large\" name=\"wpforms[fields][91]\" ><\/div><div id=\"wpforms-2113-field_96-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"96\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_96\">Telephone Number<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_96\" class=\"wpforms-field-medium\" name=\"wpforms[fields][96]\" ><\/div><div id=\"wpforms-2113-field_100-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"100\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_100\">Supervisors Name<\/label><input type=\"text\" id=\"wpforms-2113-field_100\" class=\"wpforms-field-large\" name=\"wpforms[fields][100]\" ><\/div><div id=\"wpforms-2113-field_104-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"104\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_104\">Your Position and Duties<\/label><input type=\"text\" id=\"wpforms-2113-field_104\" class=\"wpforms-field-large\" name=\"wpforms[fields][104]\" ><\/div><div id=\"wpforms-2113-field_113-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"113\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_113\">Reason for Leaving<\/label><textarea id=\"wpforms-2113-field_113\" class=\"wpforms-field-medium\" name=\"wpforms[fields][113]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_80-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"80\"><h3 id=\"wpforms-2113-field_80\" name=\"wpforms[fields][80]\">Employer 4<\/h3><\/div><div id=\"wpforms-2113-field_84-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_84\">Name of Employer<\/label><input type=\"text\" id=\"wpforms-2113-field_84\" class=\"wpforms-field-large\" name=\"wpforms[fields][84]\" ><\/div><div id=\"wpforms-2113-field_86-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_86\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_86\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][86][address1]\" ><label for=\"wpforms-2113-field_86\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_86-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][86][city]\" ><label for=\"wpforms-2113-field_86-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2113-field_86-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][86][state]\" ><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2113-field_86-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_86-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][86][postal]\" ><label for=\"wpforms-2113-field_86-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-2113-field_92-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_92\">Type of Business<\/label><input type=\"text\" id=\"wpforms-2113-field_92\" class=\"wpforms-field-large\" name=\"wpforms[fields][92]\" ><\/div><div id=\"wpforms-2113-field_97-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"97\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_97\">Telephone Number<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_97\" class=\"wpforms-field-medium\" name=\"wpforms[fields][97]\" ><\/div><div id=\"wpforms-2113-field_101-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"101\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_101\">Supervisors Name<\/label><input type=\"text\" id=\"wpforms-2113-field_101\" class=\"wpforms-field-large\" name=\"wpforms[fields][101]\" ><\/div><div id=\"wpforms-2113-field_105-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"105\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_105\">Your Position and Duties<\/label><input type=\"text\" id=\"wpforms-2113-field_105\" class=\"wpforms-field-large\" name=\"wpforms[fields][105]\" ><\/div><div id=\"wpforms-2113-field_114-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"114\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_114\">Reason for Leaving<\/label><textarea id=\"wpforms-2113-field_114\" class=\"wpforms-field-medium\" name=\"wpforms[fields][114]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_115-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"115\"><h3 id=\"wpforms-2113-field_115\" name=\"wpforms[fields][115]\">Military Service<\/h3><\/div><div id=\"wpforms-2113-field_116-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"116\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_116\">Have you obtained any special skills or abilities as the result of service in the military?<\/label><ul id=\"wpforms-2113-field_116\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_116_1\" name=\"wpforms[fields][116]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_116_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_116_2\" name=\"wpforms[fields][116]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_116_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_117-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"117\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_117\">If so, describe<\/label><textarea id=\"wpforms-2113-field_117\" class=\"wpforms-field-medium\" name=\"wpforms[fields][117]\" ><\/textarea><\/div><div id=\"wpforms-2113-field_118-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"118\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"4\" data-formid=\"2113\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-2113-field_119-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"119\"><h3 id=\"wpforms-2113-field_119\" name=\"wpforms[fields][119]\">References<\/h3><\/div><div id=\"wpforms-2113-field_121-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"121\"><div id=\"wpforms-2113-field_121\" class=\"wpforms-field-large wpforms-field-row\" name=\"wpforms[fields][121]\"><p><strong>List below three persons who have first-hand knowledge of your work performance within the last three years.<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_122-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"122\"><h3 id=\"wpforms-2113-field_122\" name=\"wpforms[fields][122]\">Reference 1<\/h3><\/div><div id=\"wpforms-2113-field_120-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"120\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_120\">Reference Name<\/label><input type=\"text\" id=\"wpforms-2113-field_120\" class=\"wpforms-field-large\" name=\"wpforms[fields][120]\" ><\/div><div id=\"wpforms-2113-field_127-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"127\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_127\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_127\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][127][address1]\" ><label for=\"wpforms-2113-field_127\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_127-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][127][city]\" ><label for=\"wpforms-2113-field_127-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2113-field_127-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][127][state]\" ><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2113-field_127-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><\/div><div id=\"wpforms-2113-field_130-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"130\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_130\">Phone<\/label><input type=\"tel\" id=\"wpforms-2113-field_130\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][130]\" ><\/div><div id=\"wpforms-2113-field_133-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"133\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_133\">Occupation<\/label><input type=\"text\" id=\"wpforms-2113-field_133\" class=\"wpforms-field-large\" name=\"wpforms[fields][133]\" ><\/div><div id=\"wpforms-2113-field_137-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"137\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_137\">Number of Years Acquainted<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_137\" class=\"wpforms-field-medium\" name=\"wpforms[fields][137]\" ><\/div><div id=\"wpforms-2113-field_123-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"123\"><h3 id=\"wpforms-2113-field_123\" name=\"wpforms[fields][123]\">Reference 2<\/h3><\/div><div id=\"wpforms-2113-field_125-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"125\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_125\">Reference Name<\/label><input type=\"text\" id=\"wpforms-2113-field_125\" class=\"wpforms-field-large\" name=\"wpforms[fields][125]\" ><\/div><div id=\"wpforms-2113-field_128-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"128\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_128\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_128\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][128][address1]\" ><label for=\"wpforms-2113-field_128\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_128-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][128][city]\" ><label for=\"wpforms-2113-field_128-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2113-field_128-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][128][state]\" ><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2113-field_128-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><\/div><div id=\"wpforms-2113-field_131-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"131\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_131\">Phone<\/label><input type=\"tel\" id=\"wpforms-2113-field_131\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][131]\" ><\/div><div id=\"wpforms-2113-field_134-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"134\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_134\">Occupation<\/label><input type=\"text\" id=\"wpforms-2113-field_134\" class=\"wpforms-field-large\" name=\"wpforms[fields][134]\" ><\/div><div id=\"wpforms-2113-field_138-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"138\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_138\">Number of Years Acquainted<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_138\" class=\"wpforms-field-medium\" name=\"wpforms[fields][138]\" ><\/div><div id=\"wpforms-2113-field_124-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"124\"><h3 id=\"wpforms-2113-field_124\" name=\"wpforms[fields][124]\">Reference 3<\/h3><\/div><div id=\"wpforms-2113-field_126-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"126\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_126\">Reference Name<\/label><input type=\"text\" id=\"wpforms-2113-field_126\" class=\"wpforms-field-large\" name=\"wpforms[fields][126]\" ><\/div><div id=\"wpforms-2113-field_129-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"129\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_129\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2113-field_129\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][129][address1]\" ><label for=\"wpforms-2113-field_129\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2113-field_129-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][129][city]\" ><label for=\"wpforms-2113-field_129-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2113-field_129-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][129][state]\" ><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2113-field_129-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><\/div><div id=\"wpforms-2113-field_132-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"132\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_132\">Phone<\/label><input type=\"tel\" id=\"wpforms-2113-field_132\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][132]\" ><\/div><div id=\"wpforms-2113-field_136-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"136\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_136\">Occupation<\/label><input type=\"text\" id=\"wpforms-2113-field_136\" class=\"wpforms-field-large\" name=\"wpforms[fields][136]\" ><\/div><div id=\"wpforms-2113-field_139-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"139\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_139\">Number of Years Acquainted<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2113-field_139\" class=\"wpforms-field-medium\" name=\"wpforms[fields][139]\" ><\/div><div id=\"wpforms-2113-field_140-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"140\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"5\" data-formid=\"2113\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6 last \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-2113-field_141-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"141\"><h3 id=\"wpforms-2113-field_141\" name=\"wpforms[fields][141]\">Applicant Certification, Authorizations and Understanding<\/h3><\/div><div id=\"wpforms-2113-field_142-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"142\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_142\">If you have a Resume, please upload it here<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"142\"\n\t\tdata-form-id=\"2113\"\n\t\tdata-input-name=\"wpforms_2113_142\"\n\t\tdata-extensions=\"doc,xls,ppt,pdf,png,jpg\"\n\t\tdata-max-size=\"20971520\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"52428800\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2113-field_142\"\n\t\tname=\"wpforms_2113_142\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2113-field_143-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"143\"><label class=\"wpforms-field-label\" for=\"wpforms-2113-field_143\">If you have a Cover Letter, please upload it here<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"143\"\n\t\tdata-form-id=\"2113\"\n\t\tdata-input-name=\"wpforms_2113_143\"\n\t\tdata-extensions=\"doc,xls,ppt,pdf,png,jpg\"\n\t\tdata-max-size=\"20971520\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"52428800\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2113-field_143\"\n\t\tname=\"wpforms_2113_143\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2113-field_145-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"145\"><div id=\"wpforms-2113-field_145\" class=\"wpforms-field-large wpforms-field-row\" name=\"wpforms[fields][145]\"><p>Please Read Below. This application is not complete until all statements below have been read and checked <strong>'Yes'<\/strong>.<\/p>\n<p>I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_146-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"146\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2113-field_146\">I hereby certify select <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_146\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_146_1\" name=\"wpforms[fields][146]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_146_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_146_2\" name=\"wpforms[fields][146]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_146_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_147-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"147\"><div id=\"wpforms-2113-field_147\" class=\"wpforms-field-large wpforms-field-row\" name=\"wpforms[fields][147]\"><p>I hereby authorize Sutter-Yuba Mosquito &amp; Vector Control District to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment and, further, authorize my former employers to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_148-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"148\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2113-field_148\">I hereby authorize select\t <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_148\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_148_1\" name=\"wpforms[fields][148]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_148_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_148_2\" name=\"wpforms[fields][148]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_148_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_149-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"149\"><div id=\"wpforms-2113-field_149\" class=\"wpforms-field-large wpforms-field-row\" name=\"wpforms[fields][149]\"><p>I understand that nothing contained in the application or conveyed during any interview which may be granted is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company's designated representative.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2113-field_150-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"150\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2113-field_150\">I understand that nothing select <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2113-field_150\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_150_1\" name=\"wpforms[fields][150]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_150_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2113-field_150_2\" name=\"wpforms[fields][150]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2113-field_150_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2113-field_27-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"27\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha\" style=\"display:none;\"><div class=\"g-recaptcha\" data-sitekey=\"6LeU9Z4lAAAAAIUPStfoVhEliM5Nx6txVqv29J6Z\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"2113\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-2113\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/sutter-yubamvcd.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":2037,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/pages\/2123"}],"collection":[{"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/comments?post=2123"}],"version-history":[{"count":1,"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/pages\/2123\/revisions"}],"predecessor-version":[{"id":2124,"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/pages\/2123\/revisions\/2124"}],"up":[{"embeddable":true,"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/pages\/2037"}],"wp:attachment":[{"href":"https:\/\/sutter-yubamvcd.org\/wp-json\/wp\/v2\/media?parent=2123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}