{"id":956,"date":"2020-02-26T09:52:21","date_gmt":"2020-02-26T09:52:21","guid":{"rendered":"http:\/\/valleyhealthcaress.com\/?page_id=956"},"modified":"2026-08-12T21:25:03","modified_gmt":"2026-08-12T21:25:03","slug":"application-form","status":"publish","type":"page","link":"https:\/\/valleyhealthcaress.com\/index.php\/application-form\/","title":{"rendered":"APPLICATION FORM"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"956\" class=\"elementor elementor-956\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8a26379 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8a26379\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1f2544c\" data-id=\"1f2544c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ef5e02f elementor-widget elementor-widget-shortcode\" data-id=\"ef5e02f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"wpforms-container \" id=\"wpforms-954\"><form id=\"wpforms-form-954\" class=\"wpforms-validate wpforms-form\" data-formid=\"954\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/956\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator none\" data-indicator=\"none\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \"><div id=\"wpforms-954-field_19-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"19\"><\/div><div id=\"wpforms-954-field_3-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"3\"><h3 id=\"wpforms-954-field_3\" name=\"wpforms[fields][3]\">VALLEY HEALTHCARE SERVICES SOUTH, LLC<\/h3><div class=\"wpforms-field-description\">AN EQUAL OPPORTUNITY EMPLOYER<\/div><\/div><div id=\"wpforms-954-field_4-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"4\"><h3 id=\"wpforms-954-field_4\" name=\"wpforms[fields][4]\">APPLICATION FOR EMPLOYMENT<\/h3><div class=\"wpforms-field-description\">All prospective employees will receive consideration without discrimination because of race, color, creed, age, natural origin or handicap. All information provided herein will be kept\r\nconfidential.<\/div><\/div><div id=\"wpforms-954-field_5-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"5\"><h3 id=\"wpforms-954-field_5\" name=\"wpforms[fields][5]\">PERSONAL<\/h3><\/div><div id=\"wpforms-954-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_6\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-954-field_6\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][6][first]\" required><label for=\"wpforms-954-field_6\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-954-field_6-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][6][last]\" required><label for=\"wpforms-954-field_6-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-954-field_7-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_7\">Date<\/label><input type=\"text\" id=\"wpforms-954-field_7\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"m\/d\/Y\" name=\"wpforms[fields][7][date]\" ><\/div><div id=\"wpforms-954-field_8-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_8\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-954-field_8\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][8][address1]\" ><label for=\"wpforms-954-field_8\" 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-954-field_8-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][8][city]\" ><label for=\"wpforms-954-field_8-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-954-field_8-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][8][state]\" ><label for=\"wpforms-954-field_8-state\" class=\"wpforms-field-sublabel after \">State \/ Province \/ Region<\/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-954-field_8-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][8][postal]\" ><label for=\"wpforms-954-field_8-postal\" class=\"wpforms-field-sublabel after \">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-954-field_8-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][8][country]\" ><option value=\"AF\" >Afghanistan<\/option><option value=\"AX\" >\u00c5land Islands<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Macedonia (Republic of)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SZ\" >Swaziland<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Province of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TR\" >Turkey<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"US\" >United States of America<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Viet Nam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><\/select><label for=\"wpforms-954-field_8-country\" class=\"wpforms-field-sublabel after \">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-954-field_9-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_9\">Phone<\/label><input type=\"tel\" id=\"wpforms-954-field_9\" class=\"wpforms-field-large\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][9]\" ><\/div><div id=\"wpforms-954-field_10-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_10\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-954-field_10\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][10]\" required><\/div><div id=\"wpforms-954-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_11\">Emergency contact name &amp; phone number and relationship:<\/label><input type=\"text\" id=\"wpforms-954-field_11\" class=\"wpforms-field-large\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-954-field_12-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_12\">Have you ever applied for employment with this Agency?<\/label><ul id=\"wpforms-954-field_12\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_12_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][12][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_12_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_12_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][12][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_12_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-954-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_13\">How many hours a week are you available for work?<\/label><input type=\"text\" id=\"wpforms-954-field_13\" class=\"wpforms-field-large\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-954-field_14-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_14\">Are you legally eligible for employment in the United States?<\/label><ul id=\"wpforms-954-field_14\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_14_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][14][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_14_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_14_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][14][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_14_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-954-field_120-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"120\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_120\">How did you learn of our organization? <\/label><textarea id=\"wpforms-954-field_120\" class=\"wpforms-field-medium\" name=\"wpforms[fields][120]\" ><\/textarea><\/div><div id=\"wpforms-954-field_16-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_16\">Are you willing to work:<\/label><ul id=\"wpforms-954-field_16\" data-choice-limit=\"2\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_16_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][16][]\" value=\"Evenings\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_16_1\">Evenings<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_16_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][16][]\" value=\"Weekends\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_16_2\">Weekends<\/label><\/li><\/ul><\/div><div id=\"wpforms-954-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_17\">Position applying for:<\/label><input type=\"text\" id=\"wpforms-954-field_17\" class=\"wpforms-field-large\" name=\"wpforms[fields][17]\" ><\/div><div id=\"wpforms-954-field_18-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"18\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"954\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" style=\"display:none;\"><div id=\"wpforms-954-field_21-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"21\"><h3 id=\"wpforms-954-field_21\" name=\"wpforms[fields][21]\">EDUCATION<\/h3><\/div><div id=\"wpforms-954-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_29\">College\/University<\/label><input type=\"text\" id=\"wpforms-954-field_29\" class=\"wpforms-field-large\" name=\"wpforms[fields][29]\" ><\/div><div id=\"wpforms-954-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_30\">Location<\/label><input type=\"text\" id=\"wpforms-954-field_30\" class=\"wpforms-field-large\" name=\"wpforms[fields][30]\" ><\/div><div id=\"wpforms-954-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_31\">Course of Study<\/label><input type=\"text\" id=\"wpforms-954-field_31\" class=\"wpforms-field-large\" name=\"wpforms[fields][31]\" ><div class=\"wpforms-field-description\">Degree\/Study<\/div><\/div><div id=\"wpforms-954-field_45-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"45\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"954\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" style=\"display:none;\"><div id=\"wpforms-954-field_46-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"46\"><h3 id=\"wpforms-954-field_46\" name=\"wpforms[fields][46]\">Employment:<\/h3><div class=\"wpforms-field-description\">--List the last 2 places of employment, starting with the most recent employer.<\/div><\/div><div id=\"wpforms-954-field_47-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_47\">1. Company Name:<\/label><input type=\"text\" id=\"wpforms-954-field_47\" class=\"wpforms-field-large\" name=\"wpforms[fields][47]\" ><\/div><div id=\"wpforms-954-field_48-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_48\">Telephone:<\/label><input type=\"text\" id=\"wpforms-954-field_48\" class=\"wpforms-field-large\" name=\"wpforms[fields][48]\" ><\/div><div id=\"wpforms-954-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_49\">Dates of Employment:<\/label><input type=\"text\" id=\"wpforms-954-field_49\" class=\"wpforms-field-large\" name=\"wpforms[fields][49]\" placeholder=\"From _________To__________\" ><\/div><div id=\"wpforms-954-field_78-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_78\">Address:<\/label><input type=\"text\" id=\"wpforms-954-field_78\" class=\"wpforms-field-large\" name=\"wpforms[fields][78]\" ><\/div><div id=\"wpforms-954-field_50-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_50\">City<\/label><input type=\"text\" id=\"wpforms-954-field_50\" class=\"wpforms-field-large\" name=\"wpforms[fields][50]\" ><\/div><div id=\"wpforms-954-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_51\">State<\/label><input type=\"text\" id=\"wpforms-954-field_51\" class=\"wpforms-field-large\" name=\"wpforms[fields][51]\" ><\/div><div id=\"wpforms-954-field_52-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_52\">Zip Code<\/label><input type=\"text\" id=\"wpforms-954-field_52\" class=\"wpforms-field-large\" name=\"wpforms[fields][52]\" ><\/div><div id=\"wpforms-954-field_53-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_53\">Starting Pay<\/label><input type=\"text\" id=\"wpforms-954-field_53\" class=\"wpforms-field-large\" name=\"wpforms[fields][53]\" ><\/div><div id=\"wpforms-954-field_54-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_54\">Job Title and Describe your work<\/label><input type=\"text\" id=\"wpforms-954-field_54\" class=\"wpforms-field-large\" name=\"wpforms[fields][54]\" ><\/div><div id=\"wpforms-954-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_55\">Reason for leaving<\/label><input type=\"text\" id=\"wpforms-954-field_55\" class=\"wpforms-field-large\" name=\"wpforms[fields][55]\" ><\/div><div id=\"wpforms-954-field_56-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_56\">2. Company Name:<\/label><input type=\"text\" id=\"wpforms-954-field_56\" class=\"wpforms-field-large\" name=\"wpforms[fields][56]\" ><\/div><div id=\"wpforms-954-field_57-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_57\">Telephone:<\/label><input type=\"text\" id=\"wpforms-954-field_57\" class=\"wpforms-field-large\" name=\"wpforms[fields][57]\" ><\/div><div id=\"wpforms-954-field_61-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_61\">Dates of Employment: (copy)<\/label><input type=\"text\" id=\"wpforms-954-field_61\" class=\"wpforms-field-large\" name=\"wpforms[fields][61]\" placeholder=\"From _________To__________\" ><\/div><div id=\"wpforms-954-field_58-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_58\">Address:<\/label><input type=\"text\" id=\"wpforms-954-field_58\" class=\"wpforms-field-large\" name=\"wpforms[fields][58]\" ><\/div><div id=\"wpforms-954-field_62-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_62\">City<\/label><input type=\"text\" id=\"wpforms-954-field_62\" class=\"wpforms-field-large\" name=\"wpforms[fields][62]\" ><\/div><div id=\"wpforms-954-field_63-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_63\">State<\/label><input type=\"text\" id=\"wpforms-954-field_63\" class=\"wpforms-field-large\" name=\"wpforms[fields][63]\" ><\/div><div id=\"wpforms-954-field_64-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_64\">Zip Code<\/label><input type=\"text\" id=\"wpforms-954-field_64\" class=\"wpforms-field-large\" name=\"wpforms[fields][64]\" ><\/div><div id=\"wpforms-954-field_65-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_65\">Starting Pay<\/label><input type=\"text\" id=\"wpforms-954-field_65\" class=\"wpforms-field-large\" name=\"wpforms[fields][65]\" ><\/div><div id=\"wpforms-954-field_66-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_66\">Job Title and Describe your work<\/label><input type=\"text\" id=\"wpforms-954-field_66\" class=\"wpforms-field-large\" name=\"wpforms[fields][66]\" ><\/div><div id=\"wpforms-954-field_67-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_67\">Reason for leaving<\/label><input type=\"text\" id=\"wpforms-954-field_67\" class=\"wpforms-field-large\" name=\"wpforms[fields][67]\" ><\/div><div id=\"wpforms-954-field_79-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"79\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"954\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" style=\"display:none;\"><div id=\"wpforms-954-field_82-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"82\"><h3 id=\"wpforms-954-field_82\" name=\"wpforms[fields][82]\">APPLICATION FOR EMPLOYMENT<\/h3><\/div><div id=\"wpforms-954-field_83-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_83\">Was your last name different from your present name during the above listed jobs?<\/label><ul id=\"wpforms-954-field_83\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_83_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][83][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_83_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_83_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][83][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_83_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-954-field_85-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_85\">If yes, what was your name?<\/label><input type=\"text\" id=\"wpforms-954-field_85\" class=\"wpforms-field-large\" name=\"wpforms[fields][85]\" ><\/div><div id=\"wpforms-954-field_86-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_86\">Are you currently employed?<\/label><ul id=\"wpforms-954-field_86\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_86_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][86][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_86_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_86_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][86][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_86_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-954-field_87-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_87\">Do you have reliable transportation?<\/label><ul id=\"wpforms-954-field_87\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_87_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][87][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_87_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_87_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][87][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_87_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-954-field_91-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"91\"><h3 id=\"wpforms-954-field_91\" name=\"wpforms[fields][91]\">PROFESSIONAL REFERENCES<\/h3><div class=\"wpforms-field-description\">Persons who can furnish information about job performance<\/div><\/div><div id=\"wpforms-954-field_92-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_92\">1-Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-954-field_92\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][92]\" required><\/div><div id=\"wpforms-954-field_93-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"93\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_93\">Phone<\/label><input type=\"tel\" id=\"wpforms-954-field_93\" class=\"wpforms-field-large\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][93]\" ><\/div><div id=\"wpforms-954-field_94-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"94\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_94\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-954-field_94\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][94][address1]\" ><label for=\"wpforms-954-field_94\" 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-954-field_94-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][94][city]\" ><label for=\"wpforms-954-field_94-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-954-field_94-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][94][state]\" ><label for=\"wpforms-954-field_94-state\" class=\"wpforms-field-sublabel after \">State \/ Province \/ Region<\/label><\/div><\/div><\/div><div id=\"wpforms-954-field_95-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"95\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_95\">2-Name<\/label><input type=\"text\" id=\"wpforms-954-field_95\" class=\"wpforms-field-large\" name=\"wpforms[fields][95]\" ><\/div><div id=\"wpforms-954-field_96-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"96\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_96\">Phone<\/label><input type=\"tel\" id=\"wpforms-954-field_96\" class=\"wpforms-field-large\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][96]\" ><\/div><div id=\"wpforms-954-field_97-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"97\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_97\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-954-field_97\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][97][address1]\" ><label for=\"wpforms-954-field_97\" 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-954-field_97-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][97][city]\" ><label for=\"wpforms-954-field_97-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-954-field_97-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][97][state]\" ><label for=\"wpforms-954-field_97-state\" class=\"wpforms-field-sublabel after \">State \/ Province \/ Region<\/label><\/div><\/div><\/div><div id=\"wpforms-954-field_101-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"101\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"4\" data-formid=\"954\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5 last \" style=\"display:none;\"><div id=\"wpforms-954-field_20-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"20\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><div id=\"wpforms-954-field_102-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"102\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_102\">Have you ever been convicted of a crime in the past 5 years, barring employment in a Home Care and community support Agency?<\/label><ul id=\"wpforms-954-field_102\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_102_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][102][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_102_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_102_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][102][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_102_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-954-field_103-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_103\">Conviction will not necessarily disqualify an applicant from employment. If yes, describe in full:<\/label><textarea id=\"wpforms-954-field_103\" class=\"wpforms-field-medium\" name=\"wpforms[fields][103]\" ><\/textarea><\/div><div id=\"wpforms-954-field_104-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"104\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_104\">Are you capable of performing the job set forth in the job description?<\/label><ul id=\"wpforms-954-field_104\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_104_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][104][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_104_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-954-field_104_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][104][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_104_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-954-field_105-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"105\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_105\">If you answered No, which job requirement can you not meet?<\/label><textarea id=\"wpforms-954-field_105\" class=\"wpforms-field-medium\" name=\"wpforms[fields][105]\" ><\/textarea><\/div><div id=\"wpforms-954-field_106-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"106\"><h3 id=\"wpforms-954-field_106\" name=\"wpforms[fields][106]\">CREDENTIALS\/SPECIALIZED SKILLS &amp; QUALIFICATIONS\/EQUIPMENT OPERATED<\/h3><\/div><div id=\"wpforms-954-field_108-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_108\">List all states in which licensed giving registration and expiration date. Summarize special job-related skills and qualification acquired from employment or other experience.<\/label><textarea id=\"wpforms-954-field_108\" class=\"wpforms-field-medium\" name=\"wpforms[fields][108]\" ><\/textarea><div class=\"wpforms-field-description\">I certify that the facts contained in this application are true and complete to the best of my\r\nknowledge and understand, that, if employed, falsified statements on this application SHALL BE\r\nGROUNDS FOR DISMISSAL.\r\nI Authorize complete investigation of all statements contained herein and herby give my full\r\npermission for the Agency to contact and fully discuss my background and history with all\r\npersons and entities listed above to give the Agency any and all information concerning my\r\nprevious employment and any information they may have, and release all former employees and\r\nothers listed above from all liability for any damage that my result from furnishing the same to the\r\nAgency.\r\nI understand and agree that, if hired, my employment is for no definite period arid may,\r\nregardless of the date of payment of my wages and salary, be terminated at any time for any\r\nlawful reason, without prior notice and with or without cause.\r\nThis application for employment shall be considered active for a period of time not to exceed 45\r\ndays. Any applicant wishing to be considered for employment beyond this time period shall\r\ninquire as to whether or not applications are being accepted at that time.<\/div><\/div><div id=\"wpforms-954-field_109-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"109\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_109\">Date<\/label><input type=\"text\" id=\"wpforms-954-field_109\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"m\/d\/Y\" name=\"wpforms[fields][109][date]\" ><\/div><div id=\"wpforms-954-field_110-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_110\">SIGNATURE<\/label><input type=\"text\" id=\"wpforms-954-field_110\" class=\"wpforms-field-large\" name=\"wpforms[fields][110]\" ><\/div><div id=\"wpforms-954-field_116-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"116\"><label class=\"wpforms-field-label\" for=\"wpforms-954-field_116\">Multiple Choice<\/label><ul id=\"wpforms-954-field_116\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-954-field_116_1\" name=\"wpforms[fields][116]\" value=\"First Choice\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_116_1\">First Choice<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-954-field_116_2\" name=\"wpforms[fields][116]\" value=\"Second Choice\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_116_2\">Second Choice<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-954-field_116_3\" name=\"wpforms[fields][116]\" value=\"Third Choice\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-954-field_116_3\">Third Choice<\/label><\/li><\/ul><\/div><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-954-field-hp\" class=\"wpforms-field-label\">Phone<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-954-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"954\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"3\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-954\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ffc0764 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ffc0764\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-982b4d8\" data-id=\"982b4d8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-452e9d4 elementor-widget elementor-widget-heading\" data-id=\"452e9d4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">Florida Care Provider Background Screening via Clearinghouse Education and Awareness: <\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b41cbe2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b41cbe2\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-28b0cc3\" data-id=\"28b0cc3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0f338d4 elementor-widget elementor-widget-heading\" data-id=\"0f338d4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/info.flclearinghouse.com\/\" target=\"_blank\">FlClearingHouse.com<\/a><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Florida Care Provider Background Screening via Clearinghouse Education and Awareness: 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