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  1. <script src="http://d2g9qbzl5h49rh.cloudfront.net/static/prototype.forms.js" type="text/javascript"></script>
  2. <script src="http://d2g9qbzl5h49rh.cloudfront.net/static/jotform.forms.js?3.2.7212" type="text/javascript"></script>
  3. <script type="text/javascript">
  4. JotForm.init(function(){
  5. setTimeout(function() {
  6. $('input_7').hint('ex: myname@example.com');
  7. }, 20);
  8. JotForm.onSubmissionError="jumpToSubmit";
  9. });
  10. </script>
  11. <link href="http://d2g9qbzl5h49rh.cloudfront.net/static/formCss.css?3.2.7212" rel="stylesheet" type="text/css" />
  12. <link type="text/css" rel="stylesheet" href="http://d2g9qbzl5h49rh.cloudfront.net/css/styles/nova.css?3.2.7212" />
  13. <link type="text/css" media="print" rel="stylesheet" href="http://d2g9qbzl5h49rh.cloudfront.net/css/printForm.css?3.2.7212" />
  14. <style type="text/css">
  15. .form-label-left{
  16. width:150px !important;
  17. }
  18. .form-line{
  19. padding-top:12px;
  20. padding-bottom:12px;
  21. }
  22. .form-label-right{
  23. width:150px !important;
  24. }
  25. .form-all{
  26. width:690px;
  27. color:#555 !important;
  28. font-family:"Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Verdana, sans-serif;
  29. font-size:14px;
  30. }
  31. </style>
  32.  
  33. <form class="jotform-form" action="http://submit.jotform.us/submit/51414750375150/" method="post" name="form_51414750375150" id="51414750375150" accept-charset="utf-8">
  34. <input type="hidden" name="formID" value="51414750375150" />
  35. <div class="form-all">
  36. <ul class="form-section page-section">
  37. <li id="cid_1" class="form-input-wide" data-type="control_head">
  38. <div class="form-header-group">
  39. <div class="header-text httal htvam">
  40. <h2 id="header_1" class="form-header">
  41. Personal Information
  42. </h2>
  43. </div>
  44. </div>
  45. </li>
  46. <li class="form-line" data-type="control_textbox" id="id_3">
  47. <label class="form-label form-label-left form-label-auto" id="label_3" for="input_3"> First Name </label>
  48. <div id="cid_3" class="form-input jf-required">
  49. <input type="text" class=" form-textbox" data-type="input-textbox" id="input_3" name="q3_firstName" size="20" value="" />
  50. </div>
  51. </li>
  52. <li class="form-line" data-type="control_textbox" id="id_4">
  53. <label class="form-label form-label-left form-label-auto" id="label_4" for="input_4"> Middle Initial </label>
  54. <div id="cid_4" class="form-input jf-required">
  55. <input type="text" class=" form-textbox" data-type="input-textbox" id="input_4" name="q4_middleInitial" size="20" value="" />
  56. </div>
  57. </li>
  58. <li class="form-line" data-type="control_textbox" id="id_5">
  59. <label class="form-label form-label-left form-label-auto" id="label_5" for="input_5"> Last Name </label>
  60. <div id="cid_5" class="form-input jf-required">
  61. <input type="text" class=" form-textbox" data-type="input-textbox" id="input_5" name="q5_lastName" size="20" value="" />
  62. </div>
  63. </li>
  64. <li class="form-line" data-type="control_address" id="id_6">
  65. <label class="form-label form-label-left form-label-auto" id="label_6" for="input_6"> Address </label>
  66. <div id="cid_6" class="form-input jf-required">
  67. <table summary="" undefined class="form-address-table" border="0" cellpadding="0" cellspacing="0">
  68. <tr>
  69. <td colspan="2">
  70. <span class="form-sub-label-container" style="vertical-align: top">
  71. <input class="form-textbox form-address-line" type="text" name="q6_address6[addr_line1]" id="input_6_addr_line1" />
  72. <label class="form-sub-label" for="input_6_addr_line1" id="sublabel_6_addr_line1" style="min-height: 13px;"> Street Address </label>
  73. </span>
  74. </td>
  75. </tr>
  76. <tr>
  77. <td colspan="2">
  78. <span class="form-sub-label-container" style="vertical-align: top">
  79. <input class="form-textbox form-address-line" type="text" name="q6_address6[addr_line2]" id="input_6_addr_line2" size="46" />
  80. <label class="form-sub-label" for="input_6_addr_line2" id="sublabel_6_addr_line2" style="min-height: 13px;"> Street Address Line 2 </label>
  81. </span>
  82. </td>
  83. </tr>
  84. <tr>
  85. <td width="50%">
  86. <span class="form-sub-label-container" style="vertical-align: top">
  87. <input class="form-textbox form-address-city" type="text" name="q6_address6[city]" id="input_6_city" size="21" />
  88. <label class="form-sub-label" for="input_6_city" id="sublabel_6_city" style="min-height: 13px;"> City </label>
  89. </span>
  90. </td>
  91. <td>
  92. <span class="form-sub-label-container" style="vertical-align: top">
  93. <input class="form-textbox form-address-state" type="text" name="q6_address6[state]" id="input_6_state" size="22" />
  94. <label class="form-sub-label" for="input_6_state" id="sublabel_6_state" style="min-height: 13px;"> State / Province </label>
  95. </span>
  96. </td>
  97. </tr>
  98. <tr>
  99. <td width="50%" function zip(){var iterator=Prototype.K,args=$A(arguments);if(Object.isFunction(args.last())) iterator=args.pop();var collections=[this].concat(args).map($A);return this.map(function(value,index){return iterator(collections.pluck(index));});}>
  100. <span class="form-sub-label-container" style="vertical-align: top">
  101. <input class="form-textbox form-address-postal" type="text" name="q6_address6[postal]" id="input_6_postal" size="10" />
  102. <label class="form-sub-label" for="input_6_postal" id="sublabel_6_postal" style="min-height: 13px;"> Postal / Zip Code </label>
  103. </span>
  104. </td>
  105. <td>
  106. <span class="form-sub-label-container" style="vertical-align: top">
  107. <select class="form-dropdown form-address-country" defaultcountry="" name="q6_address6[country]" id="input_6_country">
  108. <option value="" selected> Please Select </option>
  109. <option value="United States"> United States </option>
  110. <option value="Afghanistan"> Afghanistan </option>
  111. <option value="Albania"> Albania </option>
  112. <option value="Algeria"> Algeria </option>
  113. <option value="American Samoa"> American Samoa </option>
  114. <option value="Andorra"> Andorra </option>
  115. <option value="Angola"> Angola </option>
  116. <option value="Anguilla"> Anguilla </option>
  117. <option value="Antigua and Barbuda"> Antigua and Barbuda </option>
  118. <option value="Argentina"> Argentina </option>
  119. <option value="Armenia"> Armenia </option>
  120. <option value="Aruba"> Aruba </option>
  121. <option value="Australia"> Australia </option>
  122. <option value="Austria"> Austria </option>
  123. <option value="Azerbaijan"> Azerbaijan </option>
  124. <option value="The Bahamas"> The Bahamas </option>
  125. <option value="Bahrain"> Bahrain </option>
  126. <option value="Bangladesh"> Bangladesh </option>
  127. <option value="Barbados"> Barbados </option>
  128. <option value="Belarus"> Belarus </option>
  129. <option value="Belgium"> Belgium </option>
  130. <option value="Belize"> Belize </option>
  131. <option value="Benin"> Benin </option>
  132. <option value="Bermuda"> Bermuda </option>
  133. <option value="Bhutan"> Bhutan </option>
  134. <option value="Bolivia"> Bolivia </option>
  135. <option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option>
  136. <option value="Botswana"> Botswana </option>
  137. <option value="Brazil"> Brazil </option>
  138. <option value="Brunei"> Brunei </option>
  139. <option value="Bulgaria"> Bulgaria </option>
  140. <option value="Burkina Faso"> Burkina Faso </option>
  141. <option value="Burundi"> Burundi </option>
  142. <option value="Cambodia"> Cambodia </option>
  143. <option value="Cameroon"> Cameroon </option>
  144. <option value="Canada"> Canada </option>
  145. <option value="Cape Verde"> Cape Verde </option>
  146. <option value="Cayman Islands"> Cayman Islands </option>
  147. <option value="Central African Republic"> Central African Republic </option>
  148. <option value="Chad"> Chad </option>
  149. <option value="Chile"> Chile </option>
  150. <option value="People's Republic of China"> People's Republic of China </option>
  151. <option value="Republic of China"> Republic of China </option>
  152. <option value="Christmas Island"> Christmas Island </option>
  153. <option value="Cocos (Keeling) Islands"> Cocos (Keeling) Islands </option>
  154. <option value="Colombia"> Colombia </option>
  155. <option value="Comoros"> Comoros </option>
  156. <option value="Congo"> Congo </option>
  157. <option value="Cook Islands"> Cook Islands </option>
  158. <option value="Costa Rica"> Costa Rica </option>
  159. <option value="Cote d'Ivoire"> Cote d'Ivoire </option>
  160. <option value="Croatia"> Croatia </option>
  161. <option value="Cuba"> Cuba </option>
  162. <option value="Cyprus"> Cyprus </option>
  163. <option value="Czech Republic"> Czech Republic </option>
  164. <option value="Denmark"> Denmark </option>
  165. <option value="Djibouti"> Djibouti </option>
  166. <option value="Dominica"> Dominica </option>
  167. <option value="Dominican Republic"> Dominican Republic </option>
  168. <option value="Ecuador"> Ecuador </option>
  169. <option value="Egypt"> Egypt </option>
  170. <option value="El Salvador"> El Salvador </option>
  171. <option value="Equatorial Guinea"> Equatorial Guinea </option>
  172. <option value="Eritrea"> Eritrea </option>
  173. <option value="Estonia"> Estonia </option>
  174. <option value="Ethiopia"> Ethiopia </option>
  175. <option value="Falkland Islands"> Falkland Islands </option>
  176. <option value="Faroe Islands"> Faroe Islands </option>
  177. <option value="Fiji"> Fiji </option>
  178. <option value="Finland"> Finland </option>
  179. <option value="France"> France </option>
  180. <option value="French Polynesia"> French Polynesia </option>
  181. <option value="Gabon"> Gabon </option>
  182. <option value="The Gambia"> The Gambia </option>
  183. <option value="Georgia"> Georgia </option>
  184. <option value="Germany"> Germany </option>
  185. <option value="Ghana"> Ghana </option>
  186. <option value="Gibraltar"> Gibraltar </option>
  187. <option value="Greece"> Greece </option>
  188. <option value="Greenland"> Greenland </option>
  189. <option value="Grenada"> Grenada </option>
  190. <option value="Guadeloupe"> Guadeloupe </option>
  191. <option value="Guam"> Guam </option>
  192. <option value="Guatemala"> Guatemala </option>
  193. <option value="Guernsey"> Guernsey </option>
  194. <option value="Guinea"> Guinea </option>
  195. <option value="Guinea-Bissau"> Guinea-Bissau </option>
  196. <option value="Guyana"> Guyana </option>
  197. <option value="Haiti"> Haiti </option>
  198. <option value="Honduras"> Honduras </option>
  199. <option value="Hong Kong"> Hong Kong </option>
  200. <option value="Hungary"> Hungary </option>
  201. <option value="Iceland"> Iceland </option>
  202. <option value="India"> India </option>
  203. <option value="Indonesia"> Indonesia </option>
  204. <option value="Iran"> Iran </option>
  205. <option value="Iraq"> Iraq </option>
  206. <option value="Ireland"> Ireland </option>
  207. <option value="Israel"> Israel </option>
  208. <option value="Italy"> Italy </option>
  209. <option value="Jamaica"> Jamaica </option>
  210. <option value="Japan"> Japan </option>
  211. <option value="Jersey"> Jersey </option>
  212. <option value="Jordan"> Jordan </option>
  213. <option value="Kazakhstan"> Kazakhstan </option>
  214. <option value="Kenya"> Kenya </option>
  215. <option value="Kiribati"> Kiribati </option>
  216. <option value="North Korea"> North Korea </option>
  217. <option value="South Korea"> South Korea </option>
  218. <option value="Kosovo"> Kosovo </option>
  219. <option value="Kuwait"> Kuwait </option>
  220. <option value="Kyrgyzstan"> Kyrgyzstan </option>
  221. <option value="Laos"> Laos </option>
  222. <option value="Latvia"> Latvia </option>
  223. <option value="Lebanon"> Lebanon </option>
  224. <option value="Lesotho"> Lesotho </option>
  225. <option value="Liberia"> Liberia </option>
  226. <option value="Libya"> Libya </option>
  227. <option value="Liechtenstein"> Liechtenstein </option>
  228. <option value="Lithuania"> Lithuania </option>
  229. <option value="Luxembourg"> Luxembourg </option>
  230. <option value="Macau"> Macau </option>
  231. <option value="Macedonia"> Macedonia </option>
  232. <option value="Madagascar"> Madagascar </option>
  233. <option value="Malawi"> Malawi </option>
  234. <option value="Malaysia"> Malaysia </option>
  235. <option value="Maldives"> Maldives </option>
  236. <option value="Mali"> Mali </option>
  237. <option value="Malta"> Malta </option>
  238. <option value="Marshall Islands"> Marshall Islands </option>
  239. <option value="Martinique"> Martinique </option>
  240. <option value="Mauritania"> Mauritania </option>
  241. <option value="Mauritius"> Mauritius </option>
  242. <option value="Mayotte"> Mayotte </option>
  243. <option value="Mexico"> Mexico </option>
  244. <option value="Micronesia"> Micronesia </option>
  245. <option value="Moldova"> Moldova </option>
  246. <option value="Monaco"> Monaco </option>
  247. <option value="Mongolia"> Mongolia </option>
  248. <option value="Montenegro"> Montenegro </option>
  249. <option value="Montserrat"> Montserrat </option>
  250. <option value="Morocco"> Morocco </option>
  251. <option value="Mozambique"> Mozambique </option>
  252. <option value="Myanmar"> Myanmar </option>
  253. <option value="Nagorno-Karabakh"> Nagorno-Karabakh </option>
  254. <option value="Namibia"> Namibia </option>
  255. <option value="Nauru"> Nauru </option>
  256. <option value="Nepal"> Nepal </option>
  257. <option value="Netherlands"> Netherlands </option>
  258. <option value="Netherlands Antilles"> Netherlands Antilles </option>
  259. <option value="New Caledonia"> New Caledonia </option>
  260. <option value="New Zealand"> New Zealand </option>
  261. <option value="Nicaragua"> Nicaragua </option>
  262. <option value="Niger"> Niger </option>
  263. <option value="Nigeria"> Nigeria </option>
  264. <option value="Niue"> Niue </option>
  265. <option value="Norfolk Island"> Norfolk Island </option>
  266. <option value="Turkish Republic of Northern Cyprus"> Turkish Republic of Northern Cyprus </option>
  267. <option value="Northern Mariana"> Northern Mariana </option>
  268. <option value="Norway"> Norway </option>
  269. <option value="Oman"> Oman </option>
  270. <option value="Pakistan"> Pakistan </option>
  271. <option value="Palau"> Palau </option>
  272. <option value="Palestine"> Palestine </option>
  273. <option value="Panama"> Panama </option>
  274. <option value="Papua New Guinea"> Papua New Guinea </option>
  275. <option value="Paraguay"> Paraguay </option>
  276. <option value="Peru"> Peru </option>
  277. <option value="Philippines"> Philippines </option>
  278. <option value="Pitcairn Islands"> Pitcairn Islands </option>
  279. <option value="Poland"> Poland </option>
  280. <option value="Portugal"> Portugal </option>
  281. <option value="Puerto Rico"> Puerto Rico </option>
  282. <option value="Qatar"> Qatar </option>
  283. <option value="Romania"> Romania </option>
  284. <option value="Russia"> Russia </option>
  285. <option value="Rwanda"> Rwanda </option>
  286. <option value="Saint Barthelemy"> Saint Barthelemy </option>
  287. <option value="Saint Helena"> Saint Helena </option>
  288. <option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option>
  289. <option value="Saint Lucia"> Saint Lucia </option>
  290. <option value="Saint Martin"> Saint Martin </option>
  291. <option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option>
  292. <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option>
  293. <option value="Samoa"> Samoa </option>
  294. <option value="San Marino"> San Marino </option>
  295. <option value="Sao Tome and Principe"> Sao Tome and Principe </option>
  296. <option value="Saudi Arabia"> Saudi Arabia </option>
  297. <option value="Senegal"> Senegal </option>
  298. <option value="Serbia"> Serbia </option>
  299. <option value="Seychelles"> Seychelles </option>
  300. <option value="Sierra Leone"> Sierra Leone </option>
  301. <option value="Singapore"> Singapore </option>
  302. <option value="Slovakia"> Slovakia </option>
  303. <option value="Slovenia"> Slovenia </option>
  304. <option value="Solomon Islands"> Solomon Islands </option>
  305. <option value="Somalia"> Somalia </option>
  306. <option value="Somaliland"> Somaliland </option>
  307. <option value="South Africa"> South Africa </option>
  308. <option value="South Ossetia"> South Ossetia </option>
  309. <option value="Spain"> Spain </option>
  310. <option value="Sri Lanka"> Sri Lanka </option>
  311. <option value="Sudan"> Sudan </option>
  312. <option value="Suriname"> Suriname </option>
  313. <option value="Svalbard"> Svalbard </option>
  314. <option value="Swaziland"> Swaziland </option>
  315. <option value="Sweden"> Sweden </option>
  316. <option value="Switzerland"> Switzerland </option>
  317. <option value="Syria"> Syria </option>
  318. <option value="Taiwan"> Taiwan </option>
  319. <option value="Tajikistan"> Tajikistan </option>
  320. <option value="Tanzania"> Tanzania </option>
  321. <option value="Thailand"> Thailand </option>
  322. <option value="Timor-Leste"> Timor-Leste </option>
  323. <option value="Togo"> Togo </option>
  324. <option value="Tokelau"> Tokelau </option>
  325. <option value="Tonga"> Tonga </option>
  326. <option value="Transnistria Pridnestrovie"> Transnistria Pridnestrovie </option>
  327. <option value="Trinidad and Tobago"> Trinidad and Tobago </option>
  328. <option value="Tristan da Cunha"> Tristan da Cunha </option>
  329. <option value="Tunisia"> Tunisia </option>
  330. <option value="Turkey"> Turkey </option>
  331. <option value="Turkmenistan"> Turkmenistan </option>
  332. <option value="Turks and Caicos Islands"> Turks and Caicos Islands </option>
  333. <option value="Tuvalu"> Tuvalu </option>
  334. <option value="Uganda"> Uganda </option>
  335. <option value="Ukraine"> Ukraine </option>
  336. <option value="United Arab Emirates"> United Arab Emirates </option>
  337. <option value="United Kingdom"> United Kingdom </option>
  338. <option value="Uruguay"> Uruguay </option>
  339. <option value="Uzbekistan"> Uzbekistan </option>
  340. <option value="Vanuatu"> Vanuatu </option>
  341. <option value="Vatican City"> Vatican City </option>
  342. <option value="Venezuela"> Venezuela </option>
  343. <option value="Vietnam"> Vietnam </option>
  344. <option value="British Virgin Islands"> British Virgin Islands </option>
  345. <option value="Isle of Man"> Isle of Man </option>
  346. <option value="US Virgin Islands"> US Virgin Islands </option>
  347. <option value="Wallis and Futuna"> Wallis and Futuna </option>
  348. <option value="Western Sahara"> Western Sahara </option>
  349. <option value="Yemen"> Yemen </option>
  350. <option value="Zambia"> Zambia </option>
  351. <option value="Zimbabwe"> Zimbabwe </option>
  352. <option value="other"> Other </option>
  353. </select>
  354. <label class="form-sub-label" for="input_6_country" id="sublabel_6_country" style="min-height: 13px;"> Country </label>
  355. </span>
  356. </td>
  357. </tr>
  358. </table>
  359. </div>
  360. </li>
  361. <li class="form-line" data-type="control_email" id="id_7">
  362. <label class="form-label form-label-left form-label-auto" id="label_7" for="input_7"> E-mail </label>
  363. <div id="cid_7" class="form-input jf-required">
  364. <input type="email" class=" form-textbox validate[Email]" id="input_7" name="q7_email7" size="30" value="" />
  365. </div>
  366. </li>
  367. <li class="form-line" data-type="control_phone" id="id_8">
  368. <label class="form-label form-label-left form-label-auto" id="label_8" for="input_8"> Phone Number </label>
  369. <div id="cid_8" class="form-input jf-required">
  370. <span class="form-sub-label-container" style="vertical-align: top">
  371. <input class="form-textbox" type="tel" name="q8_phoneNumber8[area]" id="input_8_area" size="3">
  372. <span class="phone-separate">
  373. &nbsp;-
  374. </span>
  375. <label class="form-sub-label" for="input_8_area" id="sublabel_area" style="min-height: 13px;"> Area Code </label>
  376. </span>
  377. <span class="form-sub-label-container" style="vertical-align: top">
  378. <input class="form-textbox" type="tel" name="q8_phoneNumber8[phone]" id="input_8_phone" size="8">
  379. <label class="form-sub-label" for="input_8_phone" id="sublabel_phone" style="min-height: 13px;"> Phone Number </label>
  380. </span>
  381. </div>
  382. </li>
  383. <li id="cid_9" class="form-input-wide" data-type="control_head">
  384. <div class="form-header-group">
  385. <div class="header-text httal htvam">
  386. <h2 id="header_9" class="form-header">
  387. General
  388. </h2>
  389. </div>
  390. </div>
  391. </li>
  392. <li class="form-line" data-type="control_radio" id="id_10">
  393. <label class="form-label form-label-left form-label-auto" id="label_10" for="input_10"> Do you have an active Level 2 and Level 3 Commission Card? </label>
  394. <div id="cid_10" class="form-input jf-required">
  395. <div class="form-single-column">
  396. <span class="form-radio-item" style="clear:left;">
  397. <input type="radio" class="form-radio" id="input_10_0" name="q10_doYou" value="Yes" />
  398. <label for="input_10_0"> Yes </label>
  399. </span>
  400. <span class="clearfix">
  401. </span>
  402. <span class="form-radio-item" style="clear:left;">
  403. <input type="radio" class="form-radio" id="input_10_1" name="q10_doYou" value="No" />
  404. <label for="input_10_1"> No </label>
  405. </span>
  406. <span class="clearfix">
  407. </span>
  408. </div>
  409. </div>
  410. </li>
  411. <li class="form-line" data-type="control_radio" id="id_11">
  412. <label class="form-label form-label-left form-label-auto" id="label_11" for="input_11"> Do you have an active Level 4 Card (Personal Protection Officer)? </label>
  413. <div id="cid_11" class="form-input jf-required">
  414. <div class="form-single-column">
  415. <span class="form-radio-item" style="clear:left;">
  416. <input type="radio" class="form-radio" id="input_11_0" name="q11_doYou11" value="Yes" />
  417. <label for="input_11_0"> Yes </label>
  418. </span>
  419. <span class="clearfix">
  420. </span>
  421. <span class="form-radio-item" style="clear:left;">
  422. <input type="radio" class="form-radio" id="input_11_1" name="q11_doYou11" value="No" />
  423. <label for="input_11_1"> No </label>
  424. </span>
  425. <span class="clearfix">
  426. </span>
  427. </div>
  428. </div>
  429. </li>
  430. <li class="form-line" data-type="control_radio" id="id_12">
  431. <label class="form-label form-label-left form-label-auto" id="label_12" for="input_12"> Do you have Pepper Spray Certification? </label>
  432. <div id="cid_12" class="form-input jf-required">
  433. <div class="form-single-column">
  434. <span class="form-radio-item" style="clear:left;">
  435. <input type="radio" class="form-radio" id="input_12_0" name="q12_doYou12" value="Yes" />
  436. <label for="input_12_0"> Yes </label>
  437. </span>
  438. <span class="clearfix">
  439. </span>
  440. <span class="form-radio-item" style="clear:left;">
  441. <input type="radio" class="form-radio" id="input_12_1" name="q12_doYou12" value="No" />
  442. <label for="input_12_1"> No </label>
  443. </span>
  444. <span class="clearfix">
  445. </span>
  446. </div>
  447. </div>
  448. </li>
  449. <li class="form-line" data-type="control_radio" id="id_13">
  450. <label class="form-label form-label-left form-label-auto" id="label_13" for="input_13"> Do you have a Texas Driver's License? </label>
  451. <div id="cid_13" class="form-input jf-required">
  452. <div class="form-single-column">
  453. <span class="form-radio-item" style="clear:left;">
  454. <input type="radio" class="form-radio" id="input_13_0" name="q13_doYou13" value="Yes" />
  455. <label for="input_13_0"> Yes </label>
  456. </span>
  457. <span class="clearfix">
  458. </span>
  459. <span class="form-radio-item" style="clear:left;">
  460. <input type="radio" class="form-radio" id="input_13_1" name="q13_doYou13" value="No" />
  461. <label for="input_13_1"> No </label>
  462. </span>
  463. <span class="clearfix">
  464. </span>
  465. </div>
  466. </div>
  467. </li>
  468. <li class="form-line" data-type="control_radio" id="id_14">
  469. <label class="form-label form-label-left form-label-auto" id="label_14" for="input_14"> Do you have your own pistol and duty gear? </label>
  470. <div id="cid_14" class="form-input jf-required">
  471. <div class="form-single-column">
  472. <span class="form-radio-item" style="clear:left;">
  473. <input type="radio" class="form-radio" id="input_14_0" name="q14_doYou14" value="Yes" />
  474. <label for="input_14_0"> Yes </label>
  475. </span>
  476. <span class="clearfix">
  477. </span>
  478. <span class="form-radio-item" style="clear:left;">
  479. <input type="radio" class="form-radio" id="input_14_1" name="q14_doYou14" value="No" />
  480. <label for="input_14_1"> No </label>
  481. </span>
  482. <span class="clearfix">
  483. </span>
  484. </div>
  485. </div>
  486. </li>
  487. <li class="form-line" data-type="control_textbox" id="id_15">
  488. <label class="form-label form-label-left form-label-auto" id="label_15" for="input_15"> If Yes, please explain </label>
  489. <div id="cid_15" class="form-input jf-required">
  490. <input type="text" class=" form-textbox" data-type="input-textbox" id="input_15" name="q15_ifYes" size="20" value="" />
  491. </div>
  492. </li>
  493. <li class="form-line" data-type="control_radio" id="id_16">
  494. <label class="form-label form-label-left form-label-auto" id="label_16" for="input_16"> Do you speak any foreign languages? </label>
  495. <div id="cid_16" class="form-input jf-required">
  496. <div class="form-single-column">
  497. <span class="form-radio-item" style="clear:left;">
  498. <input type="radio" class="form-radio" id="input_16_0" name="q16_doYou16" value="Yes" />
  499. <label for="input_16_0"> Yes </label>
  500. </span>
  501. <span class="clearfix">
  502. </span>
  503. <span class="form-radio-item" style="clear:left;">
  504. <input type="radio" class="form-radio" id="input_16_1" name="q16_doYou16" value="No" />
  505. <label for="input_16_1"> No </label>
  506. </span>
  507. <span class="clearfix">
  508. </span>
  509. </div>
  510. </div>
  511. </li>
  512. <li class="form-line" data-type="control_textbox" id="id_17">
  513. <label class="form-label form-label-left form-label-auto" id="label_17" for="input_17"> If yes, which one(s)? </label>
  514. <div id="cid_17" class="form-input jf-required">
  515. <input type="text" class=" form-textbox" data-type="input-textbox" id="input_17" name="q17_ifYes17" size="20" value="" />
  516. </div>
  517. </li>
  518. <li class="form-line" data-type="control_radio" id="id_18">
  519. <label class="form-label form-label-left form-label-auto" id="label_18" for="input_18"> If applying for a Patrol Position, do you have any tickets within the last three years? </label>
  520. <div id="cid_18" class="form-input jf-required">
  521. <div class="form-single-column">
  522. <span class="form-radio-item" style="clear:left;">
  523. <input type="radio" class="form-radio" id="input_18_0" name="q18_ifApplying" value="Yes" />
  524. <label for="input_18_0"> Yes </label>
  525. </span>
  526. <span class="clearfix">
  527. </span>
  528. <span class="form-radio-item" style="clear:left;">
  529. <input type="radio" class="form-radio" id="input_18_1" name="q18_ifApplying" value="No" />
  530. <label for="input_18_1"> No </label>
  531. </span>
  532. <span class="clearfix">
  533. </span>
  534. </div>
  535. </div>
  536. </li>
  537. <li class="form-line" data-type="control_textbox" id="id_19">
  538. <label class="form-label form-label-left form-label-auto" id="label_19" for="input_19"> If yes, please explain: </label>
  539. <div id="cid_19" class="form-input jf-required">
  540. <input type="text" class=" form-textbox" data-type="input-textbox" id="input_19" name="q19_ifYes19" size="20" value="" />
  541. </div>
  542. </li>
  543. <li class="form-line" data-type="control_button" id="id_2">
  544. <div id="cid_2" class="form-input-wide">
  545. <div style="margin-left:156px" class="form-buttons-wrapper">
  546. <button id="input_2" type="submit" class="form-submit-button">
  547. Submit
  548. </button>
  549. </div>
  550. </div>
  551. </li>
  552. <li style="display:none">
  553. Should be Empty:
  554. <input type="text" name="website" value="" />
  555. </li>
  556. </ul>
  557. </div>
  558. <input type="hidden" id="simple_spc" name="simple_spc" value="51414750375150" />
  559. <script type="text/javascript">
  560. document.getElementById("si" + "mple" + "_spc").value = "51414750375150-51414750375150";
  561. </script>
  562. </form>
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