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  1. <?php
  2. /*
  3. * A Custom PHP Contact us page. Add or change form fields on line 56 and in the form itself.
  4. * Jquery is used to add/remove Bootstrap has-error class to invalid fields.
  5. */
  6.  
  7. ini_set('display_errors', 1);
  8. ini_set('display_startup_errors', 1);
  9. error_reporting(E_ALL);
  10.  
  11. /**
  12. * Get Error Class
  13. *
  14. * @return string;
  15. */
  16.  
  17. $response = '';
  18.  
  19. function getErrorClass($failedKeys, $key)
  20. {
  21. if(isset($failedKeys) && is_array($failedKeys) && in_array($key, $failedKeys))
  22. {
  23. return 'has-error';
  24. }
  25.  
  26. return '';
  27. }
  28.  
  29. // Get Previous Value
  30. function getPreviousValue($valueKey)
  31. {
  32. return isset($_POST) && !empty($_POST) && isset($_POST[$valueKey]) ? $_POST[$valueKey] : '';
  33. }
  34.  
  35. function getCheckedAttribute($valueKey, $value)
  36. {
  37. return isset($_POST[$valueKey]) && in_array($value, $_POST[$valueKey]) ? 'checked' : '';
  38. }
  39.  
  40. if(isset($_POST) && !empty($_POST))
  41. {
  42. // New Line Tag
  43. $nL = "<br />";
  44.  
  45.  
  46.  
  47. // Fuction to generate response
  48. function my_contact_form_generate_response($type, $message)
  49. {
  50. global $response;
  51.  
  52. if($type == "success")
  53. {
  54. $response = "<div class='success alert alert-success wow fadeIn' role='alert' id='success-message'> <i class='glyphicon glyphicon-thumbs-up'></i> &nbsp; {$message}</div>";
  55. }
  56. else
  57. {
  58. $response = "<div class='error alert alert-danger wow fadeIn' role='alert' id='error-message'><i class='glyphicon glyphicon-warning-sign'></i> &nbsp; {$message} </div>";
  59. }
  60. }
  61.  
  62. // Response messages
  63. $missing_content = "Please supply all required information.";
  64. $email_invalid = "Email Address Invalid.";
  65. $message_unsent = "Message was not sent. Try Again.";
  66. $message_sent = "Thanks! Your Application has been sent. We will contact you if you meet our requirements";
  67. $customFailedMessage = 'Please fill out all required fields';
  68.  
  69. // Define the fields we use, title => field name
  70. // This can be used to add fields into auto-validation below.
  71. $userVariables = [
  72.  
  73. // Personal Info
  74. 'Personal_Info' => [
  75. 'Full Name' => 'full_name',
  76. 'Date of Birth' => 'dob',
  77. 'Email' => 'email',
  78. 'Phone' => 'phone',
  79. 'City' => 'city',
  80. 'State' => 'state',
  81. 'Zip Code' => 'zip',
  82. 'Graduated HS' => 'graduated',
  83. 'Date Graduated HS' => 'grad-date',
  84. 'College Attended' => 'college',
  85. 'Collected Unemployment' => [
  86. 'key' => 'unemployment',
  87. 'allowed' => ['Yes', 'No']
  88. ]
  89. ],
  90.  
  91. // Application Info
  92. 'Application_Info' => [
  93. 'Vape Experience' => [
  94. 'key' => 'vape-experience',
  95. 'allowed' => ['None', 'Beginner', 'Intermediate', 'Expert']
  96. ],
  97. 'Job type' => [
  98. 'key' => 'job-type',
  99. 'allowed' => ['Full Time', 'Part Time']
  100. ],
  101. 'Available Hours' => [
  102. 'key' => 'avail-hours',
  103. 'allowed' => ['Weekends', 'Days', 'Nights']
  104. ],
  105. 'Total Hours Avail' => 'total-hours',
  106. 'Avail Hours Explained' => 'hours-exp',
  107. 'Avail Start Date' => 'start-date',
  108. 'Desired Hourly Rate' => 'salary',
  109. 'Drivers License' => [
  110. 'key' => 'license',
  111. 'allowed' => ['Yes', 'No']
  112. ],
  113. 'Has Own Transportation' => [
  114. 'key' => 'has-car',
  115. 'allowed' => ['Yes', 'No']
  116. ],
  117. 'Consent to Drug Test' => [
  118. 'key' => 'drug-test',
  119. 'allowed' => ['Yes', 'No']
  120. ],
  121. 'Want Employment Because' => 'why-work',
  122. 'Special Skills' => 'skills',
  123. 'Convicted of Crime' => [
  124. 'key' => 'conviction',
  125. 'allowed' => ['Yes', 'No']
  126. ],
  127. 'Conviction Explained' => 'conviction-explain'
  128. ],
  129.  
  130. // Employement History
  131. 'Employment_History' => [
  132. // Employer 1
  133. 'Employer 1' => 'employer-1-name',
  134. 'Employer 1 Phone #' => 'employer-1-phone',
  135. 'Employer 1 Job Duties' => 'employer-1-duties',
  136. 'Employer 1 Supervisor' => 'employer-1-supervisor',
  137. 'Employer 1 Start Date' => 'job1-start-date',
  138. 'Employer 1 End Date' => 'job1-end-date',
  139. 'Employer 1 Reason for Leaving' => 'employer-1-reason',
  140. 'Employer 1 Contact Previous' => [
  141. 'key' => 'employer-1-contact',
  142. 'allowed' => ['Yes', 'No']
  143. ],
  144. // Employer 2
  145. 'Employer 2' => 'employer-2-name',
  146. 'Employer 2 Phone #' => 'employer-2-phone',
  147. 'Employer 2 Job Duties' => 'employer-2-duties',
  148. 'Employer 2 Supervisor' => 'employer-2-supervisor',
  149. 'Employer 2 Start Date' => 'job2-start-date',
  150. 'Employer 2 End Date' => 'job2-end-date',
  151. 'Employer 2 Reason for Leaving' => 'employer-2-reason',
  152. 'Employer 2 Contact Previous' => [
  153. 'key' => 'employer-2-contact',
  154. 'allowed' => ['Yes', 'No']
  155. ],
  156. // Employer 3
  157. 'Employer 3' => 'employer-3-name',
  158. 'Employer 3 Phone #' => 'employer-3-phone',
  159. 'Employer 3 Job Duties' => 'employer-3-duties',
  160. 'Employer 3 Supervisor' => 'employer-3-supervisor',
  161. 'Employer 3 Start Date' => 'job3-start-date',
  162. 'Employer 3 End Date' => 'job3-end-date',
  163. 'Employer 3 Reason for Leaving' => 'employer-3-reason',
  164. 'Employer 3 Contact Previous' => [
  165. 'key' => 'employer-3-contact',
  166. 'allowed' => ['Yes', 'No']
  167. ]
  168. ],
  169.  
  170. ];// end of form fields
  171.  
  172.  
  173. // Instantiate variables for failed, successful validated fields
  174. $failedFields = [];
  175. $validFields = [];
  176. $failedKeys = [];
  177.  
  178. // Loop through each variable defined above, and check it's validity as a non-blank string.
  179. // If successful, add it to the message array and strip all tags for security, and trim whitespace
  180. if(!empty($_POST))
  181. {
  182. foreach($userVariables as $section => $userVariableList)
  183. {
  184. foreach($userVariableList as $title => $userField)
  185. {
  186. if(is_array($userField))
  187. {
  188. if(isset($userField['key']) && $userField['key'] != '' && isset($userField['allowed']) && !empty($userField['allowed']))
  189. {
  190. $key = $userField['key'];
  191.  
  192. if(!isset($_POST[$key]) || $_POST[$key] == '')
  193. {
  194. $failedFields[] = $title;
  195. $failedKeys[] = $key;
  196. }
  197. else
  198. {
  199. if(is_array($_POST[$key]))
  200. {
  201. $failValueArray = false;
  202.  
  203. foreach($_POST[$key] as $value)
  204. {
  205. if(!in_array($value, $userField['allowed']))
  206. {
  207. $failValueArray = true;
  208. continue;
  209. }
  210. }
  211.  
  212. if($failValueArray)
  213. {
  214. $failedFields[] = $title;
  215. $failedKeys[] = $key;
  216. }
  217. }
  218. else
  219. {
  220. $validFields[$section][$title] = trim(strip_tags(($_POST[$key])));
  221. }
  222. }
  223. }
  224. }
  225. else
  226. {
  227. // If our field did not pass validation, we push to failedFields array
  228. if(!isset($_POST[$userField]) || !is_string($_POST[$userField]) || $_POST[$userField] == '')
  229. {
  230. $failedFields[] = $title;
  231. $failedKeys[] = $userField;
  232. }
  233. // If successful, add this to validFields array and trim/clean the content
  234. else
  235. {
  236. $validFields[$section][$title] = trim(strip_tags(($_POST[$userField])));
  237. }
  238. }
  239. }
  240. }
  241. }
  242.  
  243. // If we have > 0 failed fields, we will send a error response to the form
  244. if(!empty($failedFields))
  245. {
  246. // Concatenate message with failed fields in the message
  247. $failureMessage = isset($customFailedMessage) && $customFailedMessage !== '' ? $customFailedMessage : "The following fields are required: " . implode(', ', $failedFields);
  248. my_contact_form_generate_response("error", $failureMessage);
  249. }
  250.  
  251. // Create HTML message
  252. $message = '<html><head>';
  253. // define the Google Font used in the message
  254. $message .='<style>@import url("https://fonts.googleapis.com/css?family=Open+Sans:400,600");</style>';
  255. $message .='</head>';
  256. $message .='<body style="font-family:Open Sans, sans-serif; font-weight:400;">';
  257. $message .= "<h3>Application for Employment with Vapers Choice</h3>";
  258. $message .= '<table rules="all" style="border-color: #666;" cellpadding="10" width="100%">';
  259.  
  260. // If we have valid fields listed above, we will concatenate a message for the email body then close the table, body, and html tags
  261. if(!empty($validFields))
  262. {
  263. foreach($validFields as $section => $fields)
  264. {
  265. if(!empty($fields))
  266. {
  267. $message .= "<tr style='background: #cdcdcd; color: #333; font-family:Open Sans, sans-serif; font-weight:600;'><td colspan='2'>".str_replace('_', ' ', $section)."</td></tr>";
  268.  
  269. foreach($fields as $title => $value)
  270. {
  271. $message .= "<tr style='background: #eee;'><td style='width:400px; font-family: Open Sans, sans-serif; margin: 0px; padding:8px; font-weight: 600;'>" . $title . ":</td><td style='font-family: Open Sans, sans-serif; margin: 0px; padding:8px; font-weight: 400;'>" . $value . "</td></tr>";
  272. }
  273. }
  274. }
  275. }
  276.  
  277. $message .= '</table></body></html>';
  278. // end message
  279.  
  280.  
  281. echo $message;die();
  282.  
  283. $uploadedFile = false;
  284. $movefile = false;
  285. $failedAttachment = false;
  286.  
  287. if(isset($_FILES['attachmentFile']) && file_exists($_FILES['attachmentFile']['tmp_name']))
  288. {
  289. $uploadedFile = $_FILES['attachmentFile'];
  290.  
  291. //Get the uploaded file information
  292. $name_of_uploaded_file = basename($uploadedFile['name']);
  293.  
  294. //get the file extension of the file
  295. $type_of_uploaded_file = substr($name_of_uploaded_file, strrpos($name_of_uploaded_file, '.') + 1);
  296.  
  297. $size_of_uploaded_file = $uploadedFile["size"] / 1024; //size in KBs
  298.  
  299. //Settings
  300. $max_allowed_file_size = 2000; // size in KB
  301. $allowed_extensions = array("doc", "docx", "pdf");
  302. $upload_overrides = array( 'test_form' => false );
  303.  
  304. //Validations
  305. if($size_of_uploaded_file > $max_allowed_file_size)
  306. {
  307. $failedKeys[] = 'attachmentFile';
  308. $failedFields[] = 'Uploaded File';
  309. $failedAttachment = true;
  310. my_contact_form_generate_response("error", "Size of uploaded file should be less than ". round($max_allowed_file_size / 1024). "mb ");
  311. }
  312.  
  313. //------ Validate the file extension
  314. $allowed_ext = false;
  315.  
  316. for($i = 0; $i <sizeof($allowed_extensions); $i++)
  317. {
  318. if(strcasecmp($allowed_extensions[$i], $type_of_uploaded_file) == 0)
  319. {
  320. $allowed_ext = true;
  321. }
  322. }
  323.  
  324. if(!$allowed_ext)
  325. {
  326. $failedKeys[] = 'attachmentFile';
  327. $failedFields[] = 'Uploaded File';
  328. $failedAttachment = true;
  329. my_contact_form_generate_response("error", "The uploaded file is not supported file type. Only the following file types are supported: ".implode(', ',$allowed_extensions));
  330. }
  331.  
  332. $movefile = $uploadedFile;
  333. }
  334.  
  335. if(empty($failedFields) && !$failedAttachment && isset($_POST['gotcha']) )//&& $_POST['gotcha'] == '')
  336. {
  337. // Mailer variables
  338. $email = $_POST['email'];
  339. $to = "info@vaperschoiceusa.com";
  340. $fromName = $_POST['full_name'];
  341. $subject = "Job Application Submisssion - Vapers Choice";
  342. $attachment = !$failedAttachment ? $movefile : false;
  343. $tmpName = false;
  344. $uid = md5(uniqid(time()));
  345. $separator = md5(time());
  346. $eol = PHP_EOL;
  347. $nmessage = '';
  348.  
  349. // main header (multipart mandatory)
  350. $header = "From: ".$fromName." <".$email.">\r\n";
  351. $header .= "Reply-To: ".$email."\r\n";
  352. $header .= "MIME-Version: 1.0\r\n";
  353. $header .= "Content-Type: multipart/mixed; boundary=\"".$uid."\"\r\n\r\n";
  354. $nmessage = "--".$uid."\r\n";
  355. $nmessage .= "Content-type:text/html; charset=iso-8859-1\r\n";
  356. $nmessage .= "Content-Transfer-Encoding: 7bit\r\n\r\n";
  357. $nmessage .= $message."\r\n\r\n";
  358.  
  359. if($attachment)
  360. {
  361. $tmpName = $attachment['tmp_name'];
  362. $filename = preg_replace('/[^a-zA-Z0-9._-]/', '', $attachment['name']);
  363. $filetype = $attachment["type"];
  364. $filetemp = $attachment["tmp_name"];
  365.  
  366. $filesize = filesize($tmpName);
  367. $handle = fopen($tmpName, "r");
  368. $content = fread($handle, $filesize);
  369. fclose($handle);
  370. $content = chunk_split(base64_encode($content));
  371.  
  372. $nmessage .= "--".$uid."\r\n";
  373. $nmessage .= "Content-Type: application/octet-stream; name=\"".$filename."\"\r\n";
  374. $nmessage .= "Content-Transfer-Encoding: base64\r\n";
  375. $nmessage .= "Content-Disposition: attachment; filename=\"".$filename."\"\r\n\r\n";
  376. $nmessage .= $content."\r\n\r\n";
  377. $nmessage .= "--".$uid."--";
  378. }
  379.  
  380. // Create the message and send, returning success variable
  381. $sent = mail($to, $subject, $nmessage, $header);
  382.  
  383. // If successful, kick back success on form
  384. if($sent)
  385. {
  386. my_contact_form_generate_response("success", $message_sent);
  387. }
  388. // On failure, send error response back to the form
  389. else
  390. {
  391. my_contact_form_generate_response("error", $message_unsent);
  392.  
  393. if($tmpName)
  394. {
  395. unlink($tmpName);
  396. }
  397. }
  398. }
  399. else if((isset($_POST['submitted']) && ($_POST['submitted']) || !empty($failedFields)) && !$failedAttachment)
  400. {
  401. my_contact_form_generate_response("error", 'Failure to Submit Form');
  402. }
  403. }
  404. ?>
  405. <!-- End Form Logic -->
  406.  
  407.  
  408. <!DOCTYPE html>
  409. <html lang="en">
  410. <head>
  411. <meta charset="utf-8">
  412. <meta http-equiv="X-UA-Compatible" content="IE=edge">
  413. <meta name="viewport" content="width=device-width, initial-scale=1">
  414. <meta name="description" content="Vapers Choice">
  415. <link rel="icon" href="../favicon.ico">
  416.  
  417. <title>Vapers Choice</title>
  418.  
  419. <link href="../css/bootstrap.min.css" rel="stylesheet">
  420. <link rel="stylesheet" href="//code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css">
  421. <link href="../css/animate.css" rel="stylesheet">
  422. <link href="../css/styles.css" rel="stylesheet">
  423.  
  424. <script src="http://ajax.googleapis.com/ajax/libs/jquery/2.0.0/jquery.min.js"></script>
  425. <script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script>
  426. </head>
  427.  
  428. <body>
  429.  
  430. <div id="main" class="clearfix wow fadeIn" role="main">
  431. <div id="content">
  432. <div class="container">
  433. <div class="row">
  434. <div class="col-sm-12">
  435. <div id="respond">
  436. <img src="../images/logo.png" alt="Vapers Choice logo" class="img-responsive logo-app">
  437. <form class="form-horizontal" action="" method="post" id="application_form" enctype="multipart/form-data">
  438. <fieldset>
  439. <legend class="text-center">Application For Employemnt with Vapers Choice</legend>
  440. <?php echo $response; ?>
  441. <div class="well">
  442. <p style="margin-bottom: 20px; text-align:center;">Please fill out the application form and we will get back to you ASAP!</p>
  443. <h4 class="section-title">Personal Information</h4><!-- /.section-title -->
  444.  
  445. <div class="form-group">
  446. <div class="col-sm-5">
  447. <label class="control-label">Full Name <span class="required">*</span></label>
  448. </div><!-- /.col-sm-5 -->
  449. <div class="col-sm-7">
  450. <div class="input-group">
  451. <span class="input-group-addon"><i class="glyphicon glyphicon-user"></i></span>
  452. <input name="full_name" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('full_name') ?>" required>
  453. </div><!-- /.col-sm-7 -->
  454. </div>
  455. </div>
  456.  
  457. <div class="form-group">
  458. <div class="col-sm-5">
  459. <label class="control-label">Date of Birth <span class="required">*</span></label>
  460. </div><!-- /.col-sm-5 -->
  461. <div class="col-sm-7">
  462. <div class="input-group">
  463. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  464. <input name="dob" placeholder="" class="form-control" type="text" id="datepicker" value="<?php echo getPreviousValue('dob') ?>" required>
  465. </div><!-- /.col-sm-7 -->
  466. </div>
  467. </div>
  468.  
  469. <div class="form-group">
  470. <div class="col-sm-5">
  471. <label class="control-label">E-Mail <span class="required">*</span></label>
  472. </div><!-- /.col-sm-5 -->
  473. <div class="col-sm-7">
  474. <div class="input-group">
  475. <span class="input-group-addon"><i class="glyphicon glyphicon-envelope"></i></span>
  476. <input name="email" placeholder="" class="form-control" type="email" value="<?php echo getPreviousValue('email') ?>" required>
  477. </div><!-- /.col-sm-7 -->
  478. </div>
  479. </div>
  480.  
  481. <div class="form-group">
  482. <div class="col-sm-5">
  483. <label class="control-label">Phone # <span class="required">*</span></label>
  484. </div><!-- /.col-sm-5 -->
  485. <div class="col-sm-7">
  486. <div class="input-group">
  487. <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
  488. <input name="phone" placeholder="(855)555-1212" class="form-control" type="text" value="<?php echo getPreviousValue('phone') ?>" required>
  489. </div><!-- /.col-sm-7 -->
  490. </div>
  491. </div>
  492.  
  493. <div class="form-group">
  494. <div class="col-sm-5">
  495. <label class="control-label">Street Address <span class="required">*</span></label>
  496. </div><!-- /.col-sm-5 -->
  497. <div class="col-sm-7">
  498. <div class="input-group">
  499. <span class="input-group-addon"><i class="glyphicon glyphicon-home"></i></span>
  500. <input name="street-address" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('street-address') ?>" required>
  501. </div><!-- /.col-sm-7 -->
  502. </div>
  503. </div>
  504.  
  505. <div class="form-group">
  506. <div class="col-sm-5">
  507. <label class="control-label">City <span class="required">*</span></label>
  508. </div><!-- /.col-sm-5 -->
  509. <div class="col-sm-7">
  510. <div class="input-group">
  511. <span class="input-group-addon"><i class="glyphicon glyphicon-home"></i></span>
  512. <input name="city" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('city') ?>" required>
  513. </div><!-- /.col-sm-7 -->
  514. </div>
  515. </div>
  516.  
  517. <div class="form-group">
  518. <div class="col-sm-5">
  519. <label class="control-label">State <span class="required">*</span></label>
  520. </div><!-- /.col-sm-5 -->
  521. <div class="col-sm-7">
  522. <div class="input-group">
  523. <span class="input-group-addon"><i class="glyphicon glyphicon-home"></i></span>
  524. <input name="state" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('state') ?>" required>
  525. </div><!-- /.col-sm-7 -->
  526. </div>
  527. </div>
  528.  
  529. <div class="form-group">
  530. <div class="col-sm-5">
  531. <label class="control-label">Zip Code <span class="required">*</span></label>
  532. </div><!-- /.col-sm-5 -->
  533. <div class="col-sm-7">
  534. <div class="input-group">
  535. <span class="input-group-addon"><i class="glyphicon glyphicon-home"></i></span>
  536. <input name="zip" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('zip') ?>" required>
  537. </div><!-- /.col-sm-7 -->
  538. </div>
  539. </div>
  540.  
  541.  
  542. <div class="form-group">
  543. <div class="col-sm-5">
  544. <label class="control-label">Graduated High School? <span class="required">*</span></label>
  545. </div><!-- /.col-sm-5 -->
  546. <div class="col-sm-7">
  547. <div class="input-group">
  548. <label class="radio-inline">
  549. <input type="radio" name="graduated" id="graduated-yes" value="Yes" required <?php echo getCheckedAttribute('graduated', 'Yes') ?>> Yes
  550. </label>
  551. <label class="radio-inline">
  552. <input type="radio" name="graduated" id="graduated-no" value="No" required <?php echo getCheckedAttribute('graduated', 'No') ?>> No
  553. </label>
  554. </div>
  555. </div><!-- /.col-sm-7 -->
  556. </div>
  557.  
  558. <div class="form-group">
  559. <div class="col-sm-5">
  560. <label class="control-label">Year Graduated</label>
  561. </div><!-- /.col-sm-5 -->
  562. <div class="col-sm-3">
  563. <div class="input-group">
  564. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  565. <input name="grad-date" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('grad-date') ?>">
  566. </div><!-- /.col-sm-3 -->
  567. </div>
  568. </div>
  569.  
  570.  
  571. <div class="form-group">
  572. <div class="col-sm-5">
  573. <label class="control-label">College</label>
  574. </div><!-- /.col-sm-5 -->
  575. <div class="col-sm-7">
  576. <div class="input-group">
  577. <span class="input-group-addon"><i class="glyphicon glyphicon-education"></i></span>
  578. <input name="college" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('college') ?>">
  579. </div><!-- /.col-sm-7 -->
  580. </div>
  581. </div>
  582.  
  583. <div class="form-group">
  584. <div class="col-sm-5">
  585. <label class="control-label">Have you collected unemployment in the last 60 days?<span class="required">*</span></label>
  586. </div><!-- /.col-sm-5 -->
  587. <div class="col-sm-7">
  588. <div class="input-group">
  589. <label class="radio-inline">
  590. <input type="radio" name="unemployment" id="license-yes" value="Yes" required <?php echo getCheckedAttribute('unemployment', 'Yes') ?>> Yes
  591. </label>
  592. <label class="radio-inline">
  593. <input type="radio" name="unemployment" id="license-no" value="No" required <?php echo getCheckedAttribute('unemployment', 'No') ?>> No
  594. </label>
  595. </div>
  596. </div><!-- /.col-sm-7 -->
  597. </div>
  598.  
  599. <!-- Section -->
  600. <div class="clearfix"></div><!-- /.clearfix -->
  601. <h4 class="section-title mt40">Application Information</h4><!-- /.section-title -->
  602.  
  603.  
  604. <div class="form-group">
  605. <div class="col-sm-5">
  606. <label class="control-label">Vape Experience <span class="required">*</span></label>
  607. </div><!-- /.col-sm-5 -->
  608. <div class="col-sm-7">
  609. <div class="input-group">
  610. <label class="radio-inline">
  611. <input type="radio" name="vape-experience" id="none" value="None" required <?php echo getCheckedAttribute('vape-experience', 'None') ?>> None
  612. </label>
  613. <label class="radio-inline">
  614. <input type="radio" name="vape-experience" id="beginner" value="Beginner" required <?php echo getCheckedAttribute('vape-experience', 'Beginner') ?>> Beginner
  615. </label>
  616. <label class="radio-inline">
  617. <input type="radio" name="vape-experience" id="intermediate " value="Intermediate" required <?php echo getCheckedAttribute('vape-experience', 'Intermediate') ?>> Intermediate
  618. </label>
  619. <label class="radio-inline">
  620. <input type="radio" name="vape-experience" id="expert" value="Expert" required <?php echo getCheckedAttribute('vape-experience', 'Expert') ?>> Expert
  621. </label>
  622. </div>
  623. </div><!-- /.col-sm-7 -->
  624. </div>
  625.  
  626. <div class="form-group">
  627. <div class="col-sm-5">
  628. <label class="control-label">Job type <span class="required">*</span></label>
  629. </div><!-- /.col-sm-5 -->
  630. <div class="col-sm-7">
  631. <div class="input-group">
  632. <label class="checkbox-inline">
  633. <input name="job-type[]" type="checkbox" id="full-time" value="Full Time" <?php echo getCheckedAttribute('job-type', 'Full Time') ?>> Full Time
  634. </label>
  635. <label class="checkbox-inline">
  636. <input name="job-type[]" type="checkbox" id="part-time" value="Part Time" <?php echo getCheckedAttribute('job-type', 'Part Time') ?>> Part Time
  637. </label>
  638. </div><!-- /.col-sm-7 -->
  639. </div>
  640. </div>
  641.  
  642. <div class="form-group">
  643. <div class="col-sm-5">
  644. <label class="control-label">Available Hours <span class="required">*</span></label>
  645. </div><!-- /.col-sm-5 -->
  646. <div class="col-sm-7">
  647. <div class="input-group">
  648. <label class="checkbox-inline">
  649. <input name="avail-hours[]" type="checkbox" id="weekends" value="Weekends" <?php echo getCheckedAttribute('avail-hours', 'Weekends') ?>> Weekends
  650. </label>
  651. <label class="checkbox-inline">
  652. <input name="avail-hours[]" type="checkbox" id="days" value="Days" <?php echo getCheckedAttribute('avail-hours', 'Days') ?>> Days
  653. </label>
  654. <label class="checkbox-inline">
  655. <input name="avail-hours[]" type="checkbox" id="nights" value="Nights" <?php echo getCheckedAttribute('avail-hours', 'Nights') ?>> Nights
  656. </label>
  657. </div><!-- /.col-sm-7 -->
  658. </div>
  659. </div>
  660.  
  661. <div class="form-group">
  662. <div class="col-sm-5">
  663. <label class="control-label">Hours per week? <span class="required">*</span></label>
  664. </div><!-- /.col-sm-5 -->
  665. <div class="col-sm-3">
  666. <div class="input-group">
  667. <span class="input-group-addon"><i class="glyphicon glyphicon-time"></i></span>
  668. <input name="total-hours" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('total-hours') ?>" required>
  669. </div><!-- /.col-sm-7 -->
  670. </div>
  671. </div>
  672.  
  673. <div class="form-group">
  674. <div class="col-sm-5">
  675. <label class="control-label">Hours Explained:</label>
  676. </div><!-- /.col-sm-5 -->
  677. <div class="col-sm-7">
  678. <div class="input-group">
  679. <span class="input-group-addon"><i class="glyphicon glyphicon-time"></i></span>
  680. <textarea class="form-control" name="hours-exp" required><?php echo getPreviousValue('hours-exp') ?></textarea>
  681. </div><!-- /.col-sm-7 -->
  682. </div>
  683. </div>
  684.  
  685. <div class="form-group">
  686. <div class="col-sm-5">
  687. <label class="control-label">Date you can start <span class="required">*</span></label>
  688. </div><!-- /.col-sm-5 -->
  689. <div class="col-sm-3">
  690. <div class="input-group">
  691. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  692. <input name="start-date" placeholder="" class="form-control" type="text" id="startdate" value="<?php echo getPreviousValue('start-date') ?>" required>
  693. </div><!-- /.col-sm-7 -->
  694. </div>
  695. </div>
  696.  
  697. <div class="form-group">
  698. <div class="col-sm-5">
  699. <label class="control-label">Desired hourly rate? <span class="required">*</span></label>
  700. </div><!-- /.col-sm-5 -->
  701. <div class="col-sm-3">
  702. <div class="input-group">
  703. <span class="input-group-addon"><i class="glyphicon glyphicon-ice-lolly-tasted"></i></span>
  704. <input name="salary" placeholder="$/hr" class="form-control" type="text" value="<?php echo getPreviousValue('salary') ?>" required>
  705. </div><!-- /.col-sm-7 -->
  706. </div>
  707. </div>
  708.  
  709.  
  710. <div class="form-group">
  711. <div class="col-sm-5">
  712. <label class="control-label">Do you have valid driver's license? <span class="required">*</span></label>
  713. </div><!-- /.col-sm-5 -->
  714. <div class="col-sm-7">
  715. <div class="input-group">
  716. <label class="radio-inline">
  717. <input type="radio" name="license" id="license-yes" value="Yes" required <?php echo getCheckedAttribute('license', 'Yes') ?>> Yes
  718. </label>
  719. <label class="radio-inline">
  720. <input type="radio" name="license" id="license-no" value="No" required <?php echo getCheckedAttribute('license', 'No') ?>> No
  721. </label>
  722. </div>
  723. </div><!-- /.col-sm-7 -->
  724. </div>
  725.  
  726. <div class="form-group">
  727. <div class="col-sm-5">
  728. <label class="control-label">Do you have you own transportation? <span class="required">*</span></label>
  729. </div><!-- /.col-sm-5 -->
  730. <div class="col-sm-7">
  731. <div class="input-group">
  732. <label class="radio-inline">
  733. <input type="radio" name="has-car" id="has-car-yes" value="Yes" required <?php echo getCheckedAttribute('has-car', 'Yes') ?>> Yes
  734. </label>
  735. <label class="radio-inline">
  736. <input type="radio" name="has-car" id="has-car-no" value="No" required <?php echo getCheckedAttribute('has-car', 'No') ?>> No
  737. </label>
  738. </div>
  739. </div><!-- /.col-sm-7 -->
  740. </div>
  741.  
  742. <div class="form-group">
  743. <div class="col-sm-5">
  744. <label class="control-label">Would you consent to pre-employment Drug Screening? <span class="required">*</span></label>
  745. </div><!-- /.col-sm-5 -->
  746. <div class="col-sm-7">
  747. <div class="input-group">
  748. <label class="radio-inline">
  749. <input type="radio" name="drug-test" id="drug-test-yes" value="Yes" required <?php echo getCheckedAttribute('drug-test', 'Yes') ?>> Yes
  750. </label>
  751. <label class="radio-inline">
  752. <input type="radio" name="drug-test" id="drug-test-no" value="No" required <?php echo getCheckedAttribute('drug-test', 'No') ?>> No
  753. </label>
  754. </div>
  755. </div><!-- /.col-sm-7 -->
  756. </div>
  757.  
  758. <div class="form-group">
  759. <div class="col-sm-5">
  760. <label class="control-label">Why do you want to work for us?</label>
  761. </div><!-- /.col-sm-5 -->
  762. <div class="col-sm-7">
  763. <div class="input-group">
  764. <span class="input-group-addon"><i class="glyphicon glyphicon-pencil"></i></span>
  765. <textarea class="form-control" name="why-work" required><?php echo getPreviousValue('why-work') ?></textarea>
  766. </div><!-- /.col-sm-7 -->
  767. </div>
  768. </div>
  769.  
  770. <div class="form-group">
  771. <div class="col-sm-5">
  772. <label class="control-label">Do you possess any special skills that may be an advantage as an employee?</label>
  773. </div><!-- /.col-sm-5 -->
  774. <div class="col-sm-7">
  775. <div class="input-group">
  776. <span class="input-group-addon"><i class="glyphicon glyphicon-pencil"></i></span>
  777. <textarea class="form-control" name="skills" required><?php echo getPreviousValue('skills') ?></textarea>
  778. </div><!-- /.col-sm-7 -->
  779. </div>
  780. </div>
  781.  
  782.  
  783. <div class="form-group">
  784. <div class="col-sm-5">
  785. <label class="control-label">Have you been convicted of any crime? <small>(not including traffic or parking violations)</small>? <span class="required">*</span></label>
  786. </div><!-- /.col-sm-5 -->
  787. <div class="col-sm-7">
  788. <div class="input-group">
  789. <label class="radio-inline">
  790. <input type="radio" name="conviction" id="conviction-yes" value="Yes" required <?php echo getCheckedAttribute('conviction', 'Yes') ?>> Yes
  791. </label>
  792. <label class="radio-inline">
  793. <input type="radio" name="conviction" id="conviction-no" value="No" required <?php echo getCheckedAttribute('conviction', 'No') ?>> No
  794. </label>
  795. </div>
  796. </div><!-- /.col-sm-7 -->
  797. </div>
  798.  
  799. <div class="form-group">
  800. <div class="col-sm-5">
  801. <label class="control-label">If Yes, please explain?</label>
  802. </div><!-- /.col-sm-5 -->
  803. <div class="col-sm-7">
  804. <div class="input-group">
  805. <span class="input-group-addon"><i class="glyphicon glyphicon-pencil"></i></span>
  806. <textarea class="form-control" name="conviction-explain" required><?php echo getPreviousValue('conviction-explain') ?></textarea>
  807. </div><!-- /.col-sm-7 -->
  808. </div>
  809. </div>
  810.  
  811.  
  812. <!-- Section --> <div class="clearfix"></div><!-- /.clearfix -->
  813. <h4 class="section-title mt40">Employment History</h4><!-- /.section-title -->
  814. <p>Last 3 Places of Employment (Provide all information requested accurately)</p>
  815.  
  816. <!-- Employer 1--> <div class="form-group">
  817. <div class="col-sm-5">
  818. <label class="control-label">Employer 1</label>
  819. </div><!-- /.col-sm-5 -->
  820. <div class="col-sm-7">
  821. <div class="input-group">
  822. <span class="input-group-addon"><i class="glyphicon glyphicon-briefcase"></i></span>
  823. <input name="employer-1-name" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-1-name') ?>">
  824. </div><!-- /.col-sm-7 -->
  825. </div>
  826. </div>
  827.  
  828. <div class="form-group">
  829. <div class="col-sm-5">
  830. <label class="control-label">Phone Number</label>
  831. </div><!-- /.col-sm-5 -->
  832. <div class="col-sm-7">
  833. <div class="input-group">
  834. <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
  835. <input name="employer-1-phone" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-1-phone') ?>">
  836. </div><!-- /.col-sm-7 -->
  837. </div>
  838. </div>
  839.  
  840. <div class="form-group">
  841. <div class="col-sm-5">
  842. <label class="control-label">Duties</label>
  843. </div><!-- /.col-sm-5 -->
  844. <div class="col-sm-7">
  845. <div class="input-group">
  846. <span class="input-group-addon"><i class="glyphicon glyphicon-pencil"></i></span>
  847. <textarea class="form-control" name="employer-1-duties"><?php echo getPreviousValue('employer-1-duties') ?></textarea>
  848. </div><!-- /.col-sm-7 -->
  849. </div>
  850. </div>
  851.  
  852. <div class="form-group">
  853. <div class="col-sm-5">
  854. <label class="control-label">Supervisor</label>
  855. </div><!-- /.col-sm-5 -->
  856. <div class="col-sm-7">
  857. <div class="input-group">
  858. <span class="input-group-addon"><i class="glyphicon glyphicon-user"></i></span>
  859. <input name="employer-1-supervisor" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-1-supervisor') ?>">
  860. </div><!-- /.col-sm-7 -->
  861. </div>
  862. </div>
  863.  
  864. <div class="form-group">
  865. <div class="col-sm-5">
  866. <label class="control-label">Start Date</label>
  867. </div><!-- /.col-sm-5 -->
  868. <div class="col-sm-3">
  869. <div class="input-group">
  870. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  871. <input name="job1-start-date" placeholder="" class="form-control" type="text" id="job1startdate" value="<?php echo getPreviousValue('job1-start-date') ?>">
  872. </div><!-- /.col-sm-7 -->
  873. </div>
  874. </div>
  875.  
  876. <div class="form-group">
  877. <div class="col-sm-5">
  878. <label class="control-label">End Date</label>
  879. </div><!-- /.col-sm-5 -->
  880. <div class="col-sm-3">
  881. <div class="input-group">
  882. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  883. <input name="job1-end-date" placeholder="" class="form-control" type="text" id="job1enddate" value="<?php echo getPreviousValue('job1-end-date') ?>">
  884. </div><!-- /.col-sm-7 -->
  885. </div>
  886. </div>
  887.  
  888. <div class="form-group">
  889. <div class="col-sm-5">
  890. <label class="control-label">Reason for leaving</label>
  891. </div><!-- /.col-sm-5 -->
  892. <div class="col-sm-7">
  893. <div class="input-group">
  894. <span class="input-group-addon"><i class="glyphicon glyphicon-flag"></i></span>
  895. <input name="employer-1-reason" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-1-reason') ?>">
  896. </div><!-- /.col-sm-7 -->
  897. </div>
  898. </div>
  899.  
  900. <div class="form-group">
  901. <div class="col-sm-5">
  902. <label class="control-label">May we contact to verify employment?</label>
  903. </div><!-- /.col-sm-5 -->
  904. <div class="col-sm-7">
  905. <div class="input-group">
  906. <label class="radio-inline">
  907. <input type="radio" name="employer-1-contact" id="employer-1-contact-yes" value="Yes" <?php echo getCheckedAttribute('employer-1-contact', 'Yes') ?>> Yes
  908. </label>
  909. <label class="radio-inline">
  910. <input type="radio" name="employer-1-contact" id="employer-1-contact-no" value="No" <?php echo getCheckedAttribute('employer-1-contact', 'No') ?>> No
  911. </label>
  912. </div>
  913. </div><!-- /.col-sm-7 -->
  914. </div>
  915.  
  916. <hr>
  917.  
  918.  
  919. <!-- Employer 2--> <div class="form-group">
  920. <div class="col-sm-5">
  921. <label class="control-label">Employer 2</label>
  922. </div><!-- /.col-sm-5 -->
  923. <div class="col-sm-7">
  924. <div class="input-group">
  925. <span class="input-group-addon"><i class="glyphicon glyphicon-briefcase"></i></span>
  926. <input name="employer-2-name" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-2-name') ?>">
  927. </div><!-- /.col-sm-7 -->
  928. </div>
  929. </div>
  930.  
  931. <div class="form-group">
  932. <div class="col-sm-5">
  933. <label class="control-label">Phone Number</label>
  934. </div><!-- /.col-sm-5 -->
  935. <div class="col-sm-7">
  936. <div class="input-group">
  937. <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
  938. <input name="employer-2-phone" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-2-phone') ?>">
  939. </div><!-- /.col-sm-7 -->
  940. </div>
  941. </div>
  942.  
  943. <div class="form-group">
  944. <div class="col-sm-5">
  945. <label class="control-label">Duties</label>
  946. </div><!-- /.col-sm-5 -->
  947. <div class="col-sm-7">
  948. <div class="input-group">
  949. <span class="input-group-addon"><i class="glyphicon glyphicon-pencil"></i></span>
  950. <textarea class="form-control" name="employer-2-duties"><?php echo getPreviousValue('employer-2-duties') ?></textarea>
  951. </div><!-- /.col-sm-7 -->
  952. </div>
  953. </div>
  954.  
  955. <div class="form-group">
  956. <div class="col-sm-5">
  957. <label class="control-label">Supervisor</label>
  958. </div><!-- /.col-sm-5 -->
  959. <div class="col-sm-7">
  960. <div class="input-group">
  961. <span class="input-group-addon"><i class="glyphicon glyphicon-user"></i></span>
  962. <input name="employer-2-supervisor" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-2-supervisor') ?>">
  963. </div><!-- /.col-sm-7 -->
  964. </div>
  965. </div>
  966.  
  967. <div class="form-group">
  968. <div class="col-sm-5">
  969. <label class="control-label">Start Date</label>
  970. </div><!-- /.col-sm-5 -->
  971. <div class="col-sm-3">
  972. <div class="input-group">
  973. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  974. <input name="job2-start-date" placeholder="" class="form-control" type="text" id="job2startdate" value="<?php echo getPreviousValue('job2-start-date') ?>">
  975. </div><!-- /.col-sm-7 -->
  976. </div>
  977. </div>
  978.  
  979. <div class="form-group">
  980. <div class="col-sm-5">
  981. <label class="control-label">End Date</label>
  982. </div><!-- /.col-sm-5 -->
  983. <div class="col-sm-3">
  984. <div class="input-group">
  985. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  986. <input name="job2-end-date" placeholder="" class="form-control" type="text" id="job2enddate" value="<?php echo getPreviousValue('job2-end-date') ?>">
  987. </div><!-- /.col-sm-7 -->
  988. </div>
  989. </div>
  990.  
  991. <div class="form-group">
  992. <div class="col-sm-5">
  993. <label class="control-label">Reason for leaving</label>
  994. </div><!-- /.col-sm-5 -->
  995. <div class="col-sm-7">
  996. <div class="input-group">
  997. <span class="input-group-addon"><i class="glyphicon glyphicon-flag"></i></span>
  998. <input name="employer-2-reason" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-2-reason') ?>">
  999. </div><!-- /.col-sm-7 -->
  1000. </div>
  1001. </div>
  1002.  
  1003. <div class="form-group">
  1004. <div class="col-sm-5">
  1005. <label class="control-label">May we contact to verify employment?</label>
  1006. </div><!-- /.col-sm-5 -->
  1007. <div class="col-sm-7">
  1008. <div class="input-group">
  1009. <label class="radio-inline">
  1010. <input type="radio" name="employer-2-contact" id="employer-2-contact-yes" value="Yes" <?php echo getCheckedAttribute('employer-2-contact', 'Yes') ?>> Yes
  1011. </label>
  1012. <label class="radio-inline">
  1013. <input type="radio" name="employer-2-contact" id="employer-2-contact-no" value="No" <?php echo getCheckedAttribute('employer-2-contact', 'No') ?>> No
  1014. </label>
  1015. </div>
  1016. </div><!-- /.col-sm-7 -->
  1017. </div>
  1018.  
  1019. <hr>
  1020.  
  1021. <!-- Employer 3--> <div class="form-group">
  1022. <div class="col-sm-5">
  1023. <label class="control-label">Employer 3</label>
  1024. </div><!-- /.col-sm-5 -->
  1025. <div class="col-sm-7">
  1026. <div class="input-group">
  1027. <span class="input-group-addon"><i class="glyphicon glyphicon-briefcase"></i></span>
  1028. <input name="employer-3-name" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-3-name') ?>">
  1029. </div><!-- /.col-sm-7 -->
  1030. </div>
  1031. </div>
  1032.  
  1033. <div class="form-group">
  1034. <div class="col-sm-5">
  1035. <label class="control-label">Phone Number</label>
  1036. </div><!-- /.col-sm-5 -->
  1037. <div class="col-sm-7">
  1038. <div class="input-group">
  1039. <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
  1040. <input name="employer-3-phone" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-3-phone') ?>">
  1041. </div><!-- /.col-sm-7 -->
  1042. </div>
  1043. </div>
  1044.  
  1045. <div class="form-group">
  1046. <div class="col-sm-5">
  1047. <label class="control-label">Duties</label>
  1048. </div><!-- /.col-sm-5 -->
  1049. <div class="col-sm-7">
  1050. <div class="input-group">
  1051. <span class="input-group-addon"><i class="glyphicon glyphicon-pencil"></i></span>
  1052. <textarea class="form-control" name="employer-3-duties"><?php echo getPreviousValue('employer-3-duties') ?></textarea>
  1053. </div><!-- /.col-sm-7 -->
  1054. </div>
  1055. </div>
  1056.  
  1057. <div class="form-group">
  1058. <div class="col-sm-5">
  1059. <label class="control-label">Supervisor</label>
  1060. </div><!-- /.col-sm-5 -->
  1061. <div class="col-sm-7">
  1062. <div class="input-group">
  1063. <span class="input-group-addon"><i class="glyphicon glyphicon-user"></i></span>
  1064. <input name="employer-3-supervisor" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-3-supervisor') ?>">
  1065. </div><!-- /.col-sm-7 -->
  1066. </div>
  1067. </div>
  1068.  
  1069. <div class="form-group">
  1070. <div class="col-sm-5">
  1071. <label class="control-label">Start Date</label>
  1072. </div><!-- /.col-sm-5 -->
  1073. <div class="col-sm-3">
  1074. <div class="input-group">
  1075. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  1076. <input name="job3-start-date" placeholder="" class="form-control" type="text" id="job3startdate" value="<?php echo getPreviousValue('job3-start-date') ?>">
  1077. </div><!-- /.col-sm-7 -->
  1078. </div>
  1079. </div>
  1080.  
  1081. <div class="form-group">
  1082. <div class="col-sm-5">
  1083. <label class="control-label">End Date</label>
  1084. </div><!-- /.col-sm-5 -->
  1085. <div class="col-sm-3">
  1086. <div class="input-group">
  1087. <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
  1088. <input name="job3-end-date" placeholder="" class="form-control" type="text" id="job3enddate" value="<?php echo getPreviousValue('job3-end-date') ?>">
  1089. </div><!-- /.col-sm-7 -->
  1090. </div>
  1091. </div>
  1092.  
  1093. <div class="form-group">
  1094. <div class="col-sm-5">
  1095. <label class="control-label">Reason for leaving</label>
  1096. </div><!-- /.col-sm-5 -->
  1097. <div class="col-sm-7">
  1098. <div class="input-group">
  1099. <span class="input-group-addon"><i class="glyphicon glyphicon-flag"></i></span>
  1100. <input name="employer-3-reason" placeholder="" class="form-control" type="text" value="<?php echo getPreviousValue('employer-3-reason') ?>">
  1101. </div><!-- /.col-sm-7 -->
  1102. </div>
  1103. </div>
  1104.  
  1105. <div class="form-group">
  1106. <div class="col-sm-5">
  1107. <label class="control-label">May we contact to verify employment?</label>
  1108. </div><!-- /.col-sm-5 -->
  1109. <div class="col-sm-7">
  1110. <div class="input-group">
  1111. <label class="radio-inline">
  1112. <input type="radio" name="employer-3-contact" id="employer-3-contact-yes" value="Yes" <?php echo getCheckedAttribute('employer-3-contact', 'Yes') ?>> Yes
  1113. </label>
  1114. <label class="radio-inline">
  1115. <input type="radio" name="employer-3-contact" id="employer-3-contact-no" value="No" <?php echo getCheckedAttribute('employer-3-contact', 'No') ?>> No
  1116. </label>
  1117. </div>
  1118. </div><!-- /.col-sm-7 -->
  1119. </div>
  1120.  
  1121. <!-- Section --> <div class="clearfix"></div><!-- /.clearfix -->
  1122. <h4 class="section-title mt40">Resume</h4><!-- /.section-title-->
  1123. <p style="margin-bottom: 20px;">Please upload your resume in Pdf or Word format.</p>
  1124. <input type="file" name="attachmentFile">
  1125.  
  1126.  
  1127. <!-- Section --> <div class="clearfix"></div><!-- /.clearfix -->
  1128. <h4 class="section-title mt40">Statement</h4><!-- /.section-title-->
  1129. <p>By submitting your application for employemnt you hereby confirm that all the information listed in the application above, as well as on your resume is true and accurate. I understand that my employment is contingent on a thorough background and reference check.</p>
  1130.  
  1131.  
  1132. <!--Anti-Spam Field-->
  1133. <div class="form-group hidden" id="gotcha">
  1134. <label class="control-label">Leave this field empty</label>
  1135. <div class="input-group">
  1136. <input name="gotcha" class="form-control" type="text">
  1137. </div>
  1138. </div>
  1139.  
  1140. <div class="form-group hidden">
  1141. <input type="hidden" name="submitted" value="1">
  1142. </div>
  1143.  
  1144.  
  1145. <!--Submit Button -->
  1146. <div class="form-group">
  1147. <button type="submit" class="btn btn-info">Send
  1148. <span class="glyphicon glyphicon-send"></span>
  1149. </button>
  1150. </div>
  1151.  
  1152. <script>
  1153. // Add/Remove Bootstrap "has-error" class from invalid fields on key-up and blur
  1154. jQuery('#application_form :input[required]').keyup(function ()
  1155. {
  1156. var formElement = jQuery(this);
  1157. formGroup = formElement.closest('.form-group');
  1158.  
  1159. if(formGroup.hasClass('has-error') && jQuery.trim(formElement.val()).length)
  1160. {
  1161. formGroup.removeClass('has-error');
  1162. }
  1163. });
  1164.  
  1165. jQuery('#application_form :input[required]').blur(function ()
  1166. {
  1167. var formElement = jQuery(this);
  1168. formGroup = formElement.closest('.form-group');
  1169.  
  1170. if(jQuery.trim(formElement.val()).length==0)
  1171. {
  1172. formGroup.addClass('has-error');
  1173. }
  1174. });
  1175. </script>
  1176.  
  1177. </div><!-- /.well -->
  1178. </fieldset>
  1179. </form>
  1180.  
  1181.  
  1182. </div><!--/.respond-->
  1183. </div><!--/.col-->
  1184. </div><!-- /.row-->
  1185. </div><!-- /.container -->
  1186. </div><!-- /content -->
  1187. </div><!-- /main -->
  1188.  
  1189.  
  1190. <!-- JavaScript-->
  1191. <script src="../js/bootstrap.min.js"></script>
  1192. <script src="../js/wow.js"></script>
  1193. <script src="../js/form.js"></script>
  1194. <script>
  1195. $( function() {
  1196. $( "#datepicker" ).datepicker({
  1197. changeMonth: true,
  1198. changeYear: true,
  1199. yearRange: '1960:2001'
  1200. });
  1201. $( "#startdate" ).datepicker();
  1202. $( "#job1startdate" ).datepicker();
  1203. $( "#job1enddate" ).datepicker();
  1204. $( "#job2startdate" ).datepicker();
  1205. $( "#job2enddate" ).datepicker();
  1206. $( "#job3startdate" ).datepicker();
  1207. $( "#job3enddate" ).datepicker();
  1208.  
  1209. });
  1210. </script>
  1211. </body>
  1212. </html>
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