<?php $page = 'appEnglish'; ?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="EN" lang="EN" dir="ltr">
<title>English Application</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<meta http-equiv="imagetoolbar" content="no" />
<link rel="stylesheet" href="styles/layout.css" type="text/css" />
<script type="text/javascript" src="js/jquery-1.8.2.min.js"></script>
<script type="text/javascript" src="js/ajax_submit.js"></script>
</head>
<body id="top">
<!-- ####################################################################################################### -->
<div class="wrapper col1">
</div>
<br class="clear" />
</div>
</div>
<!-- ####################################################################################################### -->
<div class="wrapper col2">
<div id="breadcrumb">
<ul>
</ul>
</div>
</div>
<!-- ####################################################################################################### -->
<div class="wrapper col3">
<div id="container">
<center><h1>Application For Employment English</h1></center>
<div id="inner-wrapper">
<div id="respond">
<form id="english1" name="english1" id="english1" method="POST" form action="actions/appSubmit.php" enctype="multipart/form-data">
<div id="response"><!--This will hold our error messages and the response from the server. --></div>
<h1>Application For Employment</h1>
Date: <input type="text" name="date" id="date" /> Position: <input type="text" name="position" id="position" /> Email: <input type="text" name="email" />
<br /> <br />
Experience: <textarea name="experience" id="experience"></textarea>
<br /> <br />
<h2>Personal Information</h2>
<br /> <br />
Last Name: <input type="text" name="lname" id="lname" /> First Name: <input type="text" name="fname" id="fname" /> Middle Name: <input type="text" name="mname" id="mname" />
<br /> <br />
Date Of Birth: <input type="text" name="dob" id="dob" /> Drivers License #: <input type="text" name="dl" id="dl" />
<br /> <br />
<h3>Address</h3>
Address: <input type="text" name="address" id="address" />
<br /> <br />
City: <input type="text" name="city" id="city" /> State: <input type="text" name="state" id="state" /> Zip Code: <input type="text" name="zip" id="zip" />
<br /> <br />
Telephone #: <input type="text" name="telephone" id="telephone" /> Cell Phone #: <input type="text" name="cell" id="cell" />
<br /> <br />
<h3>Emergency Contact</h3>
First Name: <input type="text" name="ename" id="ename" /> Last Name: <input type="text" name="elname" id="elname" /> Relationship: <input type="text" name="relationship" id="relationship" />
<br /> <br />
Telephone #: <input type="text" name="ephone" id="ephone" /> Cell Phone #: <input type="text" name="ecell" id="ecell" />
<br /> <br />
<h3>Availability To Work</h3>
Are You Available For All Shifts? <input type="radio" name="availability" id="availability" value="yes">Yes
<input type="radio" name="availability" id="availability" value="no">No<br>
<br /> <br />
Have You Worked for This Staffing Company before? <input type="radio" name="previous" id="previous" value="yes">Yes
<input type="radio" name="previous" id="previous" value="no">No
<br /> <br />
<h3>Previouse Employment</h3>
Company: <input type="text" name="company" id="company" /> Title: <input type="text" name="title" id="title" />
<br /><br />
Name Of Supervisor: <input type="text" name="supervisor" id="supervisor" /> Supervisor Phone#: <input type="text" name="supervisorphone" id="supervisorphone" />
<br /> <br />
Reasons For Leaving: <textarea name="leaving" id="leaving"></textarea>
<br /> <br />
<h3>Equal Employment Opportunity</h3>
<p>
We do not discriminate against qualified applicants based upon any protected group status, including but not limited to
race, color, creed, religion, sex (except where it is a bona fide occupational qualification), national origin, ancestry, age,
marital status, military or veteran status, sexual orientation, physical or mental disability or medical condition as defined
by applicable equal opportunity laws. </p>
<p>
To help us comply with federal/state equal opportunity record keeping, reporting and other legal requirements, we
would appreciate you voluntarily providing the information below.</p>
<p>
I certify that the information on this application is correct and I understand that any misrepresentation or omission of
any information will result in my disqualification from consideration for employment or, if employed, my dismissal. I
understand that this application is not a contract, offer, or promise of employment and that if hired, I will be able to
resign at any time for any reason. Likewise, the company can terminate my employment at any time with or without
cause, unless otherwise required by law.</p>
<p>
Offers reasonable accommodation in the employment process for individuals with disabilities. If you need assistance
in the application or hiring process to accommodate a disability, you may request an accommodation at any time
</p>
<br />
<h3>Additional Information</h3>
Are You Male Or Female?
<br />
Male <input type="radio" name="sex" id="sex" value="male"> Female <input type="radio" name="sex" id="sex" value="female"> Choose Not To Respond <input type="radio" name="sex" id="sex" value="noresponse">
<br /> <br />
Can you Provide Proof Of Work Authorization In The United States <input type="radio" name="proof" id="proof" value="yes">Yes
<input type="radio" name="proof" id="proof" value="no">No
<br /> <br />
By signing I confirm that I have read, understand and insure all the information provided on this application is correct.
<br /><br />
Signature Of Applicant: <input type="text" name="signature" id="signature" /> Date: <input type="text" name="datesign" id="datesign" /> <input name="submit" id="submit" value="Submit Application" /> <input type="reset" name="reset" value="Reset All Fields"/>
<div class="inputs">
<input type="hidden" name="honeypot" id="honeypot" value="http://" />
<input type="hidden" name="humancheck" id="humancheck" class="clear" value="" />
</form>
</div>
</div>
</div>
</div>
</div>
<!-- ####################################################################################################### -->
<div class="wrapper col4">
<?php
include("includes/footer.php")
?>
</div>
</body>
</html>