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<form id="test" method="post" action="employment-applicationreceived.php">
<div class="backgroundform">
      <li id="li_1" >
        <label class="description2" for="element_1">Name: </label>
        <input id="req_name" name= "req_name" class="element text" maxlength="255" size="28" value=""/>
     </form>

<?php
require_once "Mail.php";
require_once "Mail/mime.php";

$from = "Test <test@testing.com>";
$to = "Test <test@testing.com>";
$subject = "Test HTML email using PHP Pear w/ SMTPrnrn";
$text = "This is a text test email message";
$html = "<html><body><html><body>
<strong>PERSONAL INFORMATION</strong>
<table>
<tr style='background: #999;'><td height='2'></td><td>
<tr><td>First Name: </td><td width='500'>$req_name = $_POST['req_name'];</td>
</table></body></html>";

$crlf = "n";

$mime = new Mail_mime($crlf);
$mime->setTXTBody($text);
$mime->setHTMLBody($html);

$host = "hostname";
$port = "25";
$username = 'test@testing.com';
$password = '***';

$headers = array ('From' => $from,
  'To' => $to,
  'Subject' => $subject);
$smtp = Mail::factory('smtp',
  array ('host' => $host,
    'auth' => true,
    'username' => $username,
    'password' => $password));


$body = $mime->get();
$headers = $mime->headers($headers);

$mail = $smtp->send($to, $headers, $body);

if (PEAR::isError($mail)) {
  echo("
  " . $mail->getMessage() . "
  ");
} else {
  echo("
  Message successfully sent!
  ");
}
?>