November 18, 2008 11:26pm pst
1. hielo 1,085,207
2. hernst42 462,266
3. angelIII 387,335
4. Ray_Pas... 251,125
5. logudotcom 200,525
6. routinet 198,226
7. RQuadling 140,510
8. Roonaan 137,032
9. glcummins 134,627
10. bportlock 123,562
11. yodercm 120,826
12. nplib 108,878
13. Xyptilon2 94,157
14. cxr 93,470
15. fibo 92,235
16. rowejd 84,483
17. dr_dedo 82,410
18. gamebits 63,743
19. MMDevelo... 61,772
20. TerryAtO... 61,560
21. Squinky 56,780
22. mankowitz 53,688
23. jausions 53,040
24. jason1178 52,075
25. Michael701 50,100
1. hielo 1,102,132
2. hernst42 1,018,139
3. angelIII 972,502
4. ldbkutty 688,003
5. Roonaan 664,972
6. RQuadling 523,123
7. wasifg 506,829
8. glcummins 405,940
9. snoyes_jw 401,445
10. gamebits 319,647
11. yodercm 313,062
12. steelseth12 304,629
13. i_m_aa... 299,607
14. routinet 298,075
15. TeRReF 263,750
16. Ray_Pas... 251,125
17. Diablo84 239,472
18. nizsmo 237,079
19. dr_dedo 216,525
20. akshah123 211,024
21. Raynard7 209,268
22. logudotcom 207,493
23. WoodyRo... 207,207
24. bportlock 200,392
25. nplib 179,102
08.21.2008 at 10:51AM PDT, ID: 23667791
	[x] Attachment Details
[x]
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9.1
Adding valididate phone to the following...

Asked by rvpmis in PHP and Databases, JavaScript

Tags: Java, html, IE, Mozilla, etc

I have the following code above and below my form. I want the ability to validate phone number so it's numeric only. Same with SSN, Zip, etc etc. Also on the date fields I want it to validate the format to make sure it's MM/YY.

Let me know what I should insert and where.Start Free Trial
         
           
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             <html>
 
<head>
<meta http-equiv="Content-Language" content="en-us">
		<meta http-equiv="content-type" content="text/html; charset=UTF-8"><link href="style.css" rel="stylesheet" type="text/css">
<title>Application for Employment</title>
 
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<!-- End Div Options Select stuff-->
 
		<!-- calendar stuff -->
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		<!--
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				if(fieldType == 'text'  ||  fieldType == 'textarea'  ||  fieldType == 'password'  ||  fieldType == 'file'  ||  fieldType == 'phone'  || fieldType == 'website')
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				dateStr = fieldObj.value;
 
 
				if(required == 0  && dateStr == '')
				{
					return true;
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				if(dateStr.charAt(2) != '/'  || dateStr.charAt(5) != '/' || dateStr.length != 10)
				{
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				else	// format's okay; check max, min
				{
					currDays = parseInt(dateStr.substr(0,2),10) + parseInt(dateStr.substr(3,2),10)*30  + parseInt(dateStr.substr(6,4),10)*365;
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					if(maxDateStr != '')
					{
						maxDays = parseInt(maxDateStr.substr(0,2),10) + parseInt(maxDateStr.substr(3,2),10)*30  + parseInt(maxDateStr.substr(6,4),10)*365;
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					{
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</head>
 
<body onLoad="collapseAll()">
 
<div align="center">
	<p style="margin-top: 3px; margin-bottom: 3px">
	<img src="imgs/spacer.gif" alt="" width="9" border="0" height="8"></p>
	<center>
 
			<table width="735" border="0" cellpadding="0" cellspacing="0">
				<tr height="58">
					<td valign="bottom" width="593" bgcolor="#ebebcc" height="64">
					<p style="margin-top: 0px; margin-bottom: 0px">
					<img src="imgs/rvp_heading.gif" alt="" vspace="7" width="420" border="0" height="9" hspace="10"></td>
					<td width="142" bgcolor="#ebebcc" height="83" rowspan="2">
					<p style="margin-top: 0px; margin-bottom: 0px"><br>
					<img border="0" src="imgs/logo.gif" width="140" height="84"></td>
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				<tr height="19">
					<td valign="bottom" width="593" bgcolor="#336601" height="19">
					&nbsp;</td>
					
				</tr>
	</table>
	</center></div>
</script>
	<center>
<table width="720" border="0" cellpadding="0" cellspacing="0" bgcolor="#EBEBCC">
	<tr>
		<td><form method=post enctype=multipart/form-data action=processor.php onSubmit="return validatePage1();">
			<p style="margin-top: 0px; margin-bottom: 0px" align="center">
			<font size="2"><b><br>
			PLEASE UNDERSTAND THAT WE WILL NOT BE ABLE TO RESPOND TO TELEPHONE 
			CALLS DUE TO THE VOLUME OF APPLICATIONS RECEIVED.</b></font><span lang="ES-MX" style="font-family: 'Baskerville Old Face',serif; font-weight: 700"><br>
			&nbsp;</span></p>
			<p style="margin-top: 0px; margin-bottom: 0px" align="left">
			Qualified applicants <b>must:</b></p>
			<ul>
				<li>
				<p style="margin-top: 0px; margin-bottom: 0px" align="left">Have 
				reliable transportation.</p></li>
				<li>
				<p style="margin-top: 0px; margin-bottom: 0px" align="left">Have 
				valid documents that allow them to work in the United States.</p>
				</li>
				<li>
				<p style="margin-top: 0px; margin-bottom: 0px" align="left">Be 
				able to pass a drug test and physical.</p></li>
			</ul>
			<p class="MsoBodyText2" align="center" style="text-align:center">
			<span style="font-size: 10.0pt; font-family: 'Baskerville Old Face',serif">
			DOMAIN is a M/F/V/D/EEO/AA Employer and is committed to hiring 
			applicants who are qualified for the positions we are filling.</span></p>
			<p style="margin-top: 0px; margin-bottom: 0px" align="center">
			<table width="734">
			<tr>
		<td bgcolor="#336601" width="363">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>APPLICATION 
		FOR EMPLOYMENT</b></font></td>
		<td bgcolor="#336601" width="361">
		<p align="right"><i><font color="#FFFFFF">*</font><font color="#FFFFFF" size="2"><b> 
		Indicates required field</b></font></i></td>
	</tr>
 
			</table>
			</p>
			<p style="margin-top: 0px; margin-bottom: 0px" align="center">
			</p>
			<p style="margin-top: 0px; margin-bottom: 0px">
					&nbsp; Today&#39;s Date&nbsp;*&nbsp;</label><input type=text name=field_10 id=field_10 value="<?php echo date('Y-m-d');?>" readonly>
								
<table width="734">		
		<tr>
		<td bgcolor="#336601" width="728">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><b><font color="#FFFFFF">Personal 
		Information</font></b></td>
	</tr>
</table>
			<div align="center">
				<table cellpadding="0" cellspacing="0" width="716" height="104">
					<!-- MSTableType="nolayout" -->
					<tr>
						<td height="104" valign="top" width="716">
					<p style="margin-top: 0px; margin-bottom: 0px">Last Name&nbsp;*&nbsp;</label><input type=text name=field_1 id=field_1 size='18' value=''>&nbsp;
					First Name&nbsp;*&nbsp;</label><input type=text name=field_2 id=field_2 size='19' value=''>&nbsp;
					Middle Name&nbsp;</label><input type=text name=field_3 id=field_3 size='17' value=''><br>
					Street Address&nbsp;*&nbsp;</label><input type=text name=field_4 id=field_4 size='41' value=''><br>
					City&nbsp;*&nbsp;</label><input type=text name=field_5 id=field_5 size='18' value=''>&nbsp; 
					State&nbsp;*</label><select name=field_6 id=field_6><option value=''> </option><option value="Alabama">
					Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">
					Arizona</option><option value="Arkansas">Arkansas</option><option value="California">
					California</option><option value="Colorado">Colorado</option><option value="Connecticut">
					Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">
					Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">
					Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">
					Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">
					Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">
					Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">
					Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">
					Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">
					Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">
					Missouri</option><option value="Montana">Montana</option><option value="Nebraska">
					Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">
					New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">
					New Mexico</option><option value="New York">New York</option><option value="North Carolina">
					North Carolina</option><option value="North Dakota">North 
					Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">
					Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">
					Pennsylvania</option><option value="Rhode Island">Rhode 
					Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">
					South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">
					Texas</option><option value="Utah">Utah</option><option value="Vermont">
					Vermont</option><option value="Virginia">Virginia</option><option value="Washington">
					Washington</option><option value="West Virginia">West 
					Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">
					Wyoming</option></SELECT>&nbsp; 
					Zip Code&nbsp;*&nbsp;</label><input type=text name=field_7 id=field_7 size='20' value=''><br>
					Telephone&nbsp;*&nbsp;</label><input type=phone name=field_8 id=field_8 size=20 value='' style="background-image:url(imgs/phone.png); background-repeat: no-repeat;  padding: 2px 2px 2px 25px;">&nbsp;&nbsp; 
					Last 4 digits of Social Security Number&nbsp;*&nbsp;</label><input type=text name=field_9 id=field_9 size='5' value=''></td>
					</tr>
				</table>
			</div>
<table width="734">		
		<tr>
		<td bgcolor="#336601" width="728">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>Employment 
		Availability</b></font></td>
	</tr>
</table>
			<div align="center">
				<table cellpadding="0" cellspacing="0" width="717">
					<!-- MSTableType="nolayout" -->
					<tr>
						<td height="110" valign="top">
					<p style="margin-top: 0px; margin-bottom: 0px">Position Desired&nbsp;*<select size="1" name="field_11" id=field_11 onchange="processSelect(this.value);">
					<option value=''> </option>
					<option value="Assembler">Assembler</option>
					<option value="Forkliftdriver">Fork lift driver</option>
					<option value="ShippingReceiving">Shipping / Receiving
					</option>
					<option value="Other">Other</option>
					</select>
					</label>&nbsp;
					<div id="optionExtras">
        				<div id="Assembler" style="display:none">Qualified applicants <b>must</b> be able to perform the essential functions including:<br>
        				<ul><li>Be able to lift 25 lbs frequently.</li>
        				<li>Work at a fast, repetitive pace.</li>
        				<li>Stand 8 hours.</li>
        				<li>Stoop, squat, bend, and reach above shoulder repeatedly.</li>
        				<li>Have motor skills to operate power tools.</li>
        				<li>Pick up small fasteners.</li>
        				<li>Bend at the waist and reach </li></ul></div>
        				<div id="Forkliftdriver" style="display:none">Qualified applicants <b>must</b> be able to perform the essential functions including:<ul>
        				<li>Sit for 5-7 hours a day.</li>
						<li>Push or pull objects up to 30 pounds frequently.</li>
						<li>Lift up to 30 pounds frequently.</li>
						<li>Bend at the waist and reach above shoulder level frequently.</li>
						<li>Have the motor skills to operate various forklifts or equipment.</li>
						<li>Vision requirements include: close vision, depth perception and ability to adjust focus.</li></ul>
						</div>
        				<div id="ShippingReceiving" style="display:none">Qualified applicants <b>must</b> be able to perform the essential functions including:
        				<ul>
        				<li>Sit for 5-7 hours a day.</li>
						<li>Push or pull objects up to 30 pounds frequently.</li>
						<li>Lift up to 30 pounds frequently.</li>
						<li>Bend at the waist and reach above shoulder level frequently.</li>
						<li>Have the motor skills to operate various forklifts or equipment.</li>
						<li>Vision requirements include: close vision, depth perception and ability to adjust focus.</li></ul>
        				</div>
        				<div id="Other" style="display:none">Please specify:<input type="text" name="field_12" id="field_12"/></div>
        
					</div>
 
				Schedule Desired</label><span><input type=radio name=field_249 id=field_249_option_1 value="Full-Time" checked /><label for="field_249_option_1">Full-Time</label><input type=radio name=field_249 id=field_249_option_2 value="Part-Time" /><label for="field_249_option_2">Part-Time</label><input type=radio name=field_249 id=field_249_option_3 value="Summer" /><label for="field_249_option_3">Summer</label><input type=radio name=field_249 id=field_249_option_4 value="Temporary" /><label for="field_249_option_4">Temporary</label></span></li><span><br>
					<br>
						</label></span>
					Is there anything that 
					would prevent you from working:&nbsp;</label><br>
					Over-Time&nbsp;<span><input type=radio name=field_250 id=field_250_option_1 value="No" checked /><label for="field_54_option_1">No</label><input type=radio name=field_250 id=field_250_option_2 value="Yes" /><label for="field_54_option_2">Yes</label></span></li>
 
				<id="fieldBox_55">
					<br>
					Saturday</label><span><input type=radio name=field_251 id=field_251_option_1 value="No" checked /><label for="field_251_option_1">No</label><input type=radio name=field_251 id=field_251_option_2 value="Yes" /><label for="field_55_option_2">Yes</label></span></li>
 
				<id="fieldBox_56">
					<br>
					Sunday</label><span><input type=radio name=field_252 id=field_252_option_1 value="No" checked /><label for="field_252_option_1">No</label><input type=radio name=field_252 id=field_252_option_2 value="Yes" /><label for="field_56_option_2">Yes</label></span></li><span> 
					<br>
					<br>
						</label></span>
					What shift will you work?</label><span><input type=radio name=field_253 id=field_253_option_1 value="1st" />1st</label><input type=radio name=field_253 id=field_253_option_2 value="2nd" />2nd</label><input type=radio name=field_253 id=field_253_option_3 value="No Preference" checked />No 
					Preference<br>
					<br>
						</label></span>
					What percent of time would 
					you be willing to travel?</label><input type=text name=field_15 id=field_15 size='8' value=''>&nbsp;
					Salary Desired:&nbsp;</label><input type=text name=field_16 id=field_16 size='7' value=''>per&nbsp;</label><select size="1" name="field_17" id="field_17">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select><br>
					<br>
					Are you aware of any 
					reason(s) you cannot perform any function(s) of the job for 
					which you have applied?&nbsp;*</label><span><br>
					<input type=radio name=field_18 id=field_18_option_1 value="Yes" />Yes </label><input type=radio name=field_18 id=field_18_option_2 value="No" checked />No<br>
					</span>If yes please explain:&nbsp;<br>
					</label><textarea  name=field_19 id=field_19 rows=3 cols=75></textarea></td>
					</tr>
				</table>
			</div>
			<p style="margin-top: 0px; margin-bottom: 0px">
			</p>
			<p style="margin-top: 0px; margin-bottom: 0px">
			<table width="734">		
		<tr>
		<td bgcolor="#336601" width="728">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>Personal 
		History</b></font></td>
	</tr>
</table>
			<div align="center">
				<table cellpadding="0" cellspacing="0" width="718">
					<!-- MSTableType="nolayout" -->
					<tr>
						<td height="96" valign="top">
					<p style="margin-top: 0px; margin-bottom: 0px">Do you have a 
					legal right to work in the U.S.?&nbsp;*&nbsp;</label><span><input type=radio name=field_20 id=field_20_option_1 value="Yes" checked /><label class="" for="field_20_option_1">Yes</label><input type=radio name=field_20 id=field_20_option_2 value="No" onclick="alert('You must have a legal right to work in the U.S. to apply!')"/><label class="" for="field_20_option_2">No</label></span>&nbsp;&nbsp;&nbsp;
					<span><label class="" for="field_21_option_2"><br>
					<br>
						</label></span>
					Have you been employed by 
					R.V. Products before?&nbsp;*</label><span><input type=radio name=field_22 id=field_22_option_3 value="Yes" checked /><label class="" for="field_22_option_3">Yes </label>
						<input type=radio name=field_22 id=field_22_option_4 value="No" /><label class="" for="field_22_option_4">No<br>
					<br>
						</label></span>
					If yes, give dates&nbsp;</label><input type=text  name=field_23 id=field_23 value="MM/YY">&nbsp;
					To:&nbsp;</label><input type=text  name=field_24 id=field_24 value="MM/YY"><br>
					<br>
						Are you 18 years of age 
					or older?&nbsp;*&nbsp;</label><span><input type=radio name=field_25 id=field_25_option_1 value="Yes" checked /><label class="" for="field_25_option_1">Yes</label><input type=radio name=field_25 id=field_25_option_2 value="No" /><label class="" for="field_25_option_2">No&nbsp;
						</label></span>
						</p>
						<p style="margin-top: 0px; margin-bottom: 0px">If no, state age&nbsp;<input type=text name=field_26 id=field_26 size='20' value=''>
						<i><font size="2" color="#000000">*If 
						employed, you must furnish proof of age.</font><font size="2"></label></font></i><br>
						<br>
					How were you referred to us?&nbsp;*</label><select name=field_267 id=field_267><option value=''></option><option value="Newspaper">Newspaper</option><option value="School">School</option><option value="R.V.P. Employee">R.V.P. Employee</option><option value="On your own">On your own</option><option value="Agency">Agency</option><option value="Relative">Relative</option><option value="Other">Other</option></select>&nbsp; Name of referral 
						source:</label><input type=text name=field_28 id=field_28 size='20' value=''><br>
						<br>
						Have you ever been 
						convicted of a felony?&nbsp;*</label><span><input type=radio name=field_29 id=field_29_option_1 value="Yes" checked /><label class="" for="field_29_option_1">Yes</label><input type=radio name=field_29 id=field_29_option_2 value="No" /><label class="" for="field_29_option_2">No<br>
						</label></span>If yes, 
						please explain date, location, offense:<br>
						</label>
						<textarea  name=field_30 id=field_30 rows=3 cols=82></textarea></td>
					</tr>
				</table>
			</div>
			<p style="margin-top: 0px; margin-bottom: 0px">
			</p>
			<p style="margin-top: 0px; margin-bottom: 0px">
<table width="733">		
		<tr>
		<td bgcolor="#336601" width="727">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>Education 
		History</b></font></td>
	</tr>
</table>
			<div align="center">
				<table width="724" cellspacing="1">
					<!-- MSTableType="nolayout" -->
					<tr>
						<td height="23" valign="top" width="79">
						<p style="margin-top: 0px; margin-bottom: 0px">&nbsp; </label></td>
						<td height="23" valign="top" width="140">
						<p style="margin-top: 0px; margin-bottom: 0px">Last School 
						Attended </td>
						<td height="23" valign="top" width="92">
						<p style="margin-top: 0px; margin-bottom: 0px">Location</td>
						<td height="23" valign="top" width="121">
						<p style="margin-top: 0px; margin-bottom: 0px">Highest Grade Completed</td>
						<td height="23" valign="top" width="123">
						<p style="margin-top: 0px; margin-bottom: 0px">Date</td>
						<td height="23" valign="top" width="88">
						<p style="margin-top: 0px; margin-bottom: 0px">Major</td>
						<td height="23" valign="top" width="59">
						<p style="margin-top: 0px; margin-bottom: 0px">Minor</td>
					</tr>
					<tr>
						<td height="28" valign="top" width="79">
						<p style="margin-top: 0px; margin-bottom: 0px">High School</label></td>
						<td height="28" valign="top" width="140">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_31 id=field_31 size='18' value=''></td>
						<td height="28" valign="top" width="92">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_32 id=field_32 size='14' value=''></td>
						<td height="28" valign="top" width="121">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<select name=field_254 id=field_254><option value=''></option><option value="10">10</option><option value="11">11</option><option value="12">12</option></select></td>
						<td height="28" valign="top" width="123">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text  name=field_34 id=field_34 value="MM/YY" size="6"></td>
						<td height="28" valign="top" width="88">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_35 id=field_35 size='8' value=''></td>
						<td height="28" valign="top" width="59">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_36 id=field_36 size='9' value=''></td>
					</tr>
					<tr>
						<td height="19" valign="top" width="79">&nbsp;</td>
						<td height="19" valign="top" width="140">
						<p style="margin-top: 0px; margin-bottom: 0px"><input type=radio name=field_37 id=field_37_option_1 value="H.S. Diploma" /><label for="field_57_option_1">H.S. Diploma</label></td>
						<td height="19" valign="top" width="92">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=radio name=field_37 id=field_37_option_3 value="G.E.D." /><label for="field_37_option_3">G.E.D.</label></span></li></td>
						<td height="19" valign="top" width="121">&nbsp;</td>
						<td height="19" valign="top" width="123">&nbsp;</td>
						<td height="19" valign="top" width="88">&nbsp;</td>
						<td height="19" valign="top" width="59">&nbsp;</td>
					</tr>
					<tr>
						<td height="23" valign="top" width="79">
						<p style="margin-top: 0px; margin-bottom: 0px">College</td>
						<td height="23" valign="top" width="140">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_38 id=field_38 size='19' value=''></td>
						<td height="23" valign="top" width="92">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_39 id=field_39 size='14' value=''></td>
						<td height="23" valign="top" width="121">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<select name=field_255 id=field_255><option value=''></option><option value="2">2</option><option value="1">1</option><option value="3">3</option><option value="4">4</option></select></td>
						<td height="23" valign="top" width="123">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text  name=field_41 id=field_41 value="MM/YY" size="6"></td>
						<td height="23" valign="top" width="88">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_42 id=field_42 size='8' value=''></td>
						<td height="23" valign="top" width="59">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_43 id=field_43 size='9' value=''></td>
					</tr>
					<tr>
						<td height="6" valign="top" width="79">
						<p style="margin-top: 0px; margin-bottom: 0px">Grad School</td>
						<td height="6" valign="top" width="140">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_44 id=field_44 size='19' value=''></td>
						<td height="6" valign="top" width="92">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_45 id=field_45 size='14' value=''></td>
						<td height="6" valign="top" width="121">
						<p style="margin-top: 0px; margin-bottom: 0px"></td>
						<td height="6" valign="top" width="123">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text  name=field_47 id=field_47 value="MM/YY" size="6"></td>
						<td height="6" valign="top" width="88">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_48 id=field_48 size='8' value=''></td>
						<td height="6" valign="top" width="59">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_49 id=field_49 size='9' value=''></td>
					</tr>
					<tr>
						<td height="9" valign="top" width="79">
						<p style="margin-top: 0px; margin-bottom: 0px">Trade or 
						Vocational</td>
						<td height="9" valign="top" width="638" colspan="6">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_50 id=field_50 size='85' value=''></td>
					</tr>
					<tr>
						<td height="7" valign="top" width="79">
						<p style="margin-top: 0px; margin-bottom: 0px">Other</td>
						<td height="7" valign="top" width="638" colspan="6">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_51 id=field_51 size='85' value=''></td>
					</tr>
				</table>
			</div>
			<p style="margin-top: 0px; margin-bottom: 0px">
			</p>
			<p style="margin-top: 0px; margin-bottom: 0px">
			<table width="733">		
		<tr>
		<td bgcolor="#336601" width="727">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>U.S. 
		Military Record</b></font></td>
	</tr>
</table>
			<div align="center">
				<table cellpadding="0" cellspacing="0" width="722" height="85">
					<!-- MSTableType="nolayout" -->
					<tr>
						<td height="18" width="113" valign="top">
						<p style="margin-top: 0px; margin-bottom: 0px">Branch of 
						Service</td>
						<td height="18" width="99">
						<p style="margin-top: 0px; margin-bottom: 0px">Final Rank</td>
						<td height="18" width="214">
						<p style="margin-top: 0px; margin-bottom: 0px">Specify</td>
						<td height="18" width="138">
						<p style="margin-top: 0px; margin-bottom: 0px">Date Inducted</td>
						<td height="18" width="158">
						<p style="margin-top: 0px; margin-bottom: 0px">Date of Discharge</td>
					</tr>
					<tr>
						<td height="23" width="113">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_52 id=field_52 size='15' value=''></td>
						<td height="23" width="99">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_53 id=field_53 size='13' value=''></td>
						<td height="23" width="214">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text name=field_54 id=field_54 size='31' value=''></td>
						<td height="23" width="138">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text  name=field_55 id=field_55 value="MM/YY" size="12"></td>
						<td height="23" width="158">
						<p style="margin-top: 0px; margin-bottom: 0px">
						<input type=text  name=field_56 id=field_56 value="MM/YY" size="12"></td>
					</tr>
					<tr>
						<td height="40" width="722" colspan="5">
						<p style="margin-top: 0px; margin-bottom: 0px">In Reserves</label><span><input type=radio name=field_57 id=field_57_option_1 value="Yes" /><label class="" for="field_57_option_1">Yes</label><input type=radio name=field_57 id=field_57_option_2 value="No" />No&nbsp;&nbsp;&nbsp;
						</span>Special 
						training or duties:</label><input type=text name=field_58 id=field_58 size='48' value=''></td>
					</tr>
				</table>
			</div>
			<p style="margin-top: 0px; margin-bottom: 0px">
			</p>
			<p style="margin-top: 0px; margin-bottom: 0px">
			<table width="733">		
		<tr>
		<td bgcolor="#336601" width="727">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>Employment 
		History</b></font></td>
	</tr>
</table>
			<p style="margin-top: 0px; margin-bottom: 0px">
			</p>
			<div align="center">
				<table cellpadding="0" cellspacing="0" width="728" height="206">
					<!-- MSTableType="nolayout" -->
					<tr>
						<td valign="top" height="206" width="728">
					<p style="margin-top: 0px; margin-bottom: 0px">List all jobs, military service and self employment for the 
					past 10 years.</p>
					<p style="margin-top: 0px; margin-bottom: 0px"><b>Present or most recent employer</b></p>
					<p style="margin-top: 0px; margin-bottom: 0px">Company Name</label><input type=text name=field_59 id=field_59 size='20' value=''>&nbsp; 
					Dates employed from:</label><input type=text  name=field_60 id=field_60 value="MM/YY" size="14">
					&nbsp; To:</label><input type=text  name=field_61 id=field_61 value="MM/YY" size="13">
						<br>
					Address</label><input type=text name=field_62 id=field_62 size='24' value=''>&nbsp;
					City</label><input type=text name=field_63 id=field_63 size='17' value=''>&nbsp;
					State</label><select name=field_64 id=field_64><option value=''> </option><option value="Alabama">
					Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">
					Arizona</option><option value="Arkansas">Arkansas</option><option value="California">
					California</option><option value="Colorado">Colorado</option><option value="Connecticut">
					Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">
					Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">
					Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">
					Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">
					Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">
					Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">
					Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">
					Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">
					Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">
					Missouri</option><option value="Montana">Montana</option><option value="Nebraska">
					Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">
					New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">
					New Mexico</option><option value="New York">New York</option><option value="North Carolina">
					North Carolina</option><option value="North Dakota">North 
					Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">
					Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">
					Pennsylvania</option><option value="Rhode Island">Rhode 
					Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">
					South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">
					Texas</option><option value="Utah">Utah</option><option value="Vermont">
					Vermont</option><option value="Virginia">Virginia</option><option value="Washington">
					Washington</option><option value="West Virginia">West 
					Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">
					Wyoming</option></SELECT>Zip</label><input type=text name=field_65 id=field_65 size='13' value=''><br>
					Telephone&nbsp;</label><input type=phone name=field_66 id=field_66 size=20 value="" style="background-image:url(imgs/phone.png); background-repeat: no-repeat;  padding: 2px 2px 2px 25px;">Supervisor&#39;s 
					Name</label><input type=text name=field_67 id=field_67 size='16' value=''> 
					Your Title</label><input type=text name=field_68 id=field_68 size='20' value=''><br>
					Duties</label><input type=text name=field_69 id=field_69 size='19' value=''>
					Beginning Salary $</label><input type=text name=field_70 id=field_70 size='7' value=''>per</label><select size="1" name="field_71" id="field_71">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select>
					Ending Salary $</label><input type=text name=field_72 id=field_72 size='8' value=''>per</label><select size="1" name="field_73" id="field_73">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select><br>
					Reason for Leaving:</label><input type=text name=field_74 id=field_74 size='79' value=''></p>
					<hr>
						<p style="margin-top: 0px; margin-bottom: 0px">
					<b>Previous Employer</b><br>
					Company Name</label><input type=text name=field_75 id=field_75 size='20' value=''>&nbsp; 
					Dates employed from:</label><input type=text  name=field_76 id=field_76 value="MM/YY" size="14">
					&nbsp;
					To:</label><input type=text  name=field_77 id=field_77 value="MM/YY" size="13"><br>
					Address</label><input type=text name=field_78 id=field_78 size='24' value=''>&nbsp;
					City</label><input type=text name=field_79 id=field_79 size='17' value=''>&nbsp;
					State</label><select name=field_80 id=field_80><option value=''> </option><option value="Alabama">
					Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">
					Arizona</option><option value="Arkansas">Arkansas</option><option value="California">
					California</option><option value="Colorado">Colorado</option><option value="Connecticut">
					Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">
					Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">
					Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">
					Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">
					Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">
					Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">
					Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">
					Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">
					Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">
					Missouri</option><option value="Montana">Montana</option><option value="Nebraska">
					Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">
					New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">
					New Mexico</option><option value="New York">New York</option><option value="North Carolina">
					North Carolina</option><option value="North Dakota">North 
					Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">
					Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">
					Pennsylvania</option><option value="Rhode Island">Rhode 
					Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">
					South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">
					Texas</option><option value="Utah">Utah</option><option value="Vermont">
					Vermont</option><option value="Virginia">Virginia</option><option value="Washington">
					Washington</option><option value="West Virginia">West 
					Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">
					Wyoming</option></SELECT>Zip</label><input type=text name=field_81 id=field_81 size='13' value=''><br>
					Telephone </label>
						<input type=phone name=field_82 id=field_82 size='20' value='' style="background-image:url(imgs/phone.png); background-repeat: no-repeat; padding: 2px 2px 2px 25px;></td>
					</tr>
				</table>
			</div>
			<ul id="mainForm_1">
 
					Supervisor&#39;s Name</label><input type=text name=field_83 id=field_83 size='16' value=''>
					Your Title</label><input type=text name=field_84 id=field_84 size='19' value=''><br>
					Duties</label><input type=text name=field_85 id=field_85 size='18' value=''>
					Beginning Salary $</label><input type=text name=field_86 id=field_86 size='8' value=''>per</label><select size="1" name="field_87" id="field_87">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select>
					Ending Salary $</label><input type=text name=field_88 id=field_88 size='8' value=''>per</label><select size="1" name="field_89" id="field_89">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select><br>
					Reason for Leaving:</label><input type=text name=field_90 id=field_90 size='79' value=''><hr>
					<p style="margin-top: 0px; margin-bottom: 0px">
					<b>Previous Employer</b><br>
					Company Name</label><input type=text name=field_91 id=field_91 size='20' value=''>&nbsp; 
					Dates employed from:</label><input type=text  name=field_92 id=field_92 value="MM/YY" size="14">
					&nbsp;
					To:</label><input type=text  name=field_93 id=field_93 value="MM/YY" size="13"><br>
					Address</label><input type=text name=field_94 id=field_94 size='24' value=''>&nbsp;
					City</label><input type=text name=field_95 id=field_95 size='17' value=''>&nbsp;
					State</label><select name=field_96 id=field_96><option value=''> </option><option value="Alabama">
					Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">
					Arizona</option><option value="Arkansas">Arkansas</option><option value="California">
					California</option><option value="Colorado">Colorado</option><option value="Connecticut">
					Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">
					Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">
					Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">
					Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">
					Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">
					Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">
					Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">
					Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">
					Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">
					Missouri</option><option value="Montana">Montana</option><option value="Nebraska">
					Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">
					New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">
					New Mexico</option><option value="New York">New York</option><option value="North Carolina">
					North Carolina</option><option value="North Dakota">North 
					Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">
					Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">
					Pennsylvania</option><option value="Rhode Island">Rhode 
					Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">
					South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">
					Texas</option><option value="Utah">Utah</option><option value="Vermont">
					Vermont</option><option value="Virginia">Virginia</option><option value="Washington">
					Washington</option><option value="West Virginia">West 
					Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">
					Wyoming</option></SELECT>Zip</label><input type=text name=field_97 id=field_97 size='13' value=''><br>
					Telephone </label><input type=phone name=field_98 id=field_98 size=20 value="" style="background-image:url(imgs/phone.png); background-repeat: no-repeat;  padding: 2px 2px 2px 25px;">
					Supervisor&#39;s Name</label><input type=text name=field_99 id=field_99 size='16' value=''>
					Your Title</label><input type=text name=field_100 id=field_100 size='19' value=''><br>
					Duties</label><input type=text name=field_101 id=field_101 size='18' value=''>
					Beginning Salary $</label><input type=text name=field_102 id=field_102 size='8' value=''>per</label><select size="1" name="field_103" id="field_103">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select>
					Ending Salary $</label><input type=text name=field_104 id=field_104 size='8' value=''>per</label><select size="1" name="field_105" id="field_105">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select><br>
					Reason for Leaving:</label><input type=text name=field_106 id=field_106 size='80' value=''><hr>
					<p style="margin-top: 0px; margin-bottom: 0px">
					<b>Previous Employer</b><br>
					Company Name</label><input type=text name=field_107 id=field_107 size='20' value=''>&nbsp;
					Dates employed from:</label><input type=text  name=field_108 id=field_108 value="MM/YY" size="14">
					&nbsp;
					To:</label><input type=text  name=field_109 id=field_109 value="MM/YY" size="13"><br>
					Address</label><input type=text name=field_110 id=field_110 size='24' value=''>&nbsp;
					City</label><input type=text name=field_111 id=field_111 size='18' value=''>
					State</label><select name=field_112 id=field_112><option value=''> </option><option value="Alabama">
					Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">
					Arizona</option><option value="Arkansas">Arkansas</option><option value="California">
					California</option><option value="Colorado">Colorado</option><option value="Connecticut">
					Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">
					Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">
					Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">
					Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">
					Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">
					Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">
					Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">
					Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">
					Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">
					Missouri</option><option value="Montana">Montana</option><option value="Nebraska">
					Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">
					New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">
					New Mexico</option><option value="New York">New York</option><option value="North Carolina">
					North Carolina</option><option value="North Dakota">North 
					Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">
					Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">
					Pennsylvania</option><option value="Rhode Island">Rhode 
					Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">
					South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">
					Texas</option><option value="Utah">Utah</option><option value="Vermont">
					Vermont</option><option value="Virginia">Virginia</option><option value="Washington">
					Washington</option><option value="West Virginia">West 
					Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">
					Wyoming</option></SELECT>Zip</label><input type=text name=field_113 id=field_113 size='13' value=''><br>
					Telephone </label><input type=phone name=field_114 id=field_114 size=20 value="" style="background-image:url(imgs/phone.png); background-repeat: no-repeat;  padding: 2px 2px 2px 25px;">
					Supervisor&#39; Name</label><input type=text name=field_115 id=field_115 size='17' value=''>
					Your Title</label><input type=text name=field_116 id=field_116 size='19' value=''><br>
					Duties</label><input type=text name=field_117 id=field_117 size='17' value=''>
					Beginning Salary $</label><input type=text name=field_118 id=field_118 size='7' value=''>per</label><select size="1" name="field_119" id="field_119">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select>
					Ending Salary $</label><input type=text name=field_120 id=field_120 size='7' value=''>per</label><select size="1" name="field_121" id="field_121">
					<option value="" selected></option>
					<option value="Hour">Hour</option>
					<option value="Month">Month</option>
					<option value="Year">Year</option>
					</select><br>
					Reason for Leaving:</label><input type=text name=field_122 id=field_122 size='79' value=''></p></table>
				<p style="margin-top: 0px; margin-bottom: 0px"></p>
				<p style="margin-top: 0px; margin-bottom: 0px">
				<table width="735">		
		<tr>
		<td bgcolor="#336601" width="359">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>Skills 
		Inventory</b></font></td>
		<td bgcolor="#336601" width="366">
		<p align="right"><i><font color="#FFFFFF" size="2"><b>Check all that 
		apply</b></font></i></td>
	</tr>
</table>
				<p style="margin-top: 0px; margin-bottom: 0px">
				</p>
				<table cellpadding="0" cellspacing="0" width="719" height="162">
					<!-- MSTableType="nolayout" -->
					<tr>
						<td width="341" height="564">
						<p style="margin-top: 0px; margin-bottom: 0px"><u><b><br>
						Factory<br>
						</b></u>Assembler</label><span><input type=radio name=field_200 id=field_200_option_1 value="No" checked /><label for="field_200_option_1">No</label><input type=radio name=field_200 id=field_200_option_2 value="Yes" /><label for="field_200_option_2">Yes</label></span></li>
 
						<br>
 
					Automatic Plastic Machine Operator</label><span><input type=radio name=field_201 id=field_201_option_1 value="No" checked /><label for="field_201_option_1">No</label><input type=radio name=field_201 id=field_201_option_2 value="Yes" /><label for="field_201_option_2">Yes</label></span></li>
 
						<br>
 
					Blueprint Reading</label><span><input type=radio name=field_202 id=field_202_option_1 value="No" checked /><label for="field_202_option_1">No</label><input type=radio name=field_202 id=field_202_option_2 value="Yes" /><label for="field_202_option_2">Yes</label></span></li>
 
						<br>
					Brake Operator</label><span><input type=radio name=field_203 id=field_203_option_1 value="No" checked /><label for="field_203_option_1">No</label><input type=radio name=field_203 id=field_203_option_2 value="Yes" /><label for="field_203_option_2">Yes</label></span></li>
 
						<br>
					Inspector</label><span><input type=radio name=field_204 id=field_204_option_204 value="No" checked /><label for="field_204_option_1">No</label><input type=radio name=field_204 id=field_204_option_2 value="Yes" /><label for="field_204_option_2">Yes</label></span></li>
 
						<br>
 
					Machine Welder</label><span><input type=radio name=field_205 id=field_205_option_1 value="No" checked /><label for="field_205_option_1">No</label><input type=radio name=field_205 id=field_205_option_2 value="Yes" /><label for="field_205_option_2">Yes</label></span></li>
 
						<br>
					Metal Punch Press</label><span><input type=radio name=field_206 id=field_206_option_1 value="No" checked /><label for="field_206_option_1">No</label><input type=radio name=field_206 id=field_206_option_2 value="Yes" /><label for="field_206_option_2">Yes</label></span></li>
 
						<br>
					Multi Punch Operator</label><span><input type=radio name=field_207 id=field_207_option_1 value="No" checked /><label for="field_207_option_1">No</label><input type=radio name=field_207 id=field_207_option_2 value="Yes" /><label for="field_207_option_2">Yes</label></span></li>
 
						<br>
					Plastic Grinding Machine Operator</label><span><input type=radio name=field_208 id=field_208_option_5 value="No" checked /><label for="field_208_option_5">No</label><input type=radio name=field_208 id=field_208_option_6 value="Yes" /><label for="field_208_option_6">Yes</label></span></li>
 
						<br>
					Plastic Trimmer</label><span><input type=radio name=field_209 id=field_209_option_4 value="No" checked /><label for="field_209_option_4">No</label><input type=radio name=field_209 id=field_209_option_5 value="Yes" /><label for="field_209_option_5">Yes</label></span></li>
 
						<br>
					Press Operator (Over 70)</label><span><input type=radio name=field_210 id=field_210_option_1 value="No" checked /><label for="field_210_option_4">No</label><input type=radio name=field_210 id=field_210_option_5 value="Yes" /><label for="field_210_option_5">Yes</label></span></li>
 
						<br>
					Press Operator (Under 70)</label><span><input type=radio name=field_211 id=field_211_option_1 value="No" checked /><label for="field_211_option_1">No</label><input type=radio name=field_211 id=field_211_option_2 value="Yes" /><label for="field_211_option_2">Yes</label></span></li>
 
						<br>
					Quality Control</label><span><input type=radio name=field_212 id=field_212_option_1 value="No" checked /><label for="field_212_option_1">No</label><input type=radio name=field_212 id=field_212_option_2 value="Yes" /><label for="field_212_option_2">Yes</label></span></li>
 
						<br>
					Roll Feed Press Operator</label><span><input type=radio name=field_213 id=field_213_option_1 value="No" checked /><label for="field_213_option_1">No</label><input type=radio name=field_213 id=field_213_option_2 value="Yes" /><label for="field_213_option_2">Yes</label></span></li>
 
						<br>
					Shear Operator</label><span><input type=radio name=field_214 id=field_214_option_1 value="No" checked /><label for="field_214_option_3">No</label><input type=radio name=field_214 id=field_124_option_2 value="Yes" /><label for="field_214_option_4">Yes</label></span></li>
 
						<br>
					Silver Brazer</label><span><input type=radio name=field_215 id=field_215_option_1 value="No" checked /><label for="field_215_option_1">No</label><input type=radio name=field_215 id=field_215_option_2 value="Yes" /><label for="field_215_option_2">Yes</label></span></li>
 
						<br>
 
					Vacuum Form Plastic Machine</label><span><input type=radio name=field_216 id=field_216_option_1 value="No" checked /><label for="field_216_option_3">No</label><input type=radio name=field_216 id=field_216_option_2 value="Yes" /><label for="field_216_option_4">Yes</label></span></li><label for="field_123_option_17"><u><b><br>
						<br>
						Maintenance</b></u></label><br>
					General Maintenance</label><span><input type=radio name=field_217 id=field_217_option_1 value="No" checked /><label for="field_217_option_3">No</label><input type=radio name=field_217 id=field_217_option_2 value="Yes" /><label for="field_217_option_4">Yes</label></span></li>
 
						<br>
					Industrial Electrician</label><span><input type=radio name=field_218 id=field_218_option_1 value="No" checked /><label for="field_218_option_1">No</label><input type=radio name=field_218 id=field_218_option_2 value="Yes" /><label for="field_218_option_2">Yes</label></span></li>
 
						<br>
					Industrial Millwright</label><span><input type=radio name=field_219 id=field_219_option_1 value="No" checked /><label for="field_219_option_1">No</label><input type=radio name=field_219 id=field_219_option_2 value="Yes" /><label for="field_219_option_2">Yes</label></span></li>
 
						<br>
					Industrial Plumber</label><span><input type=radio name=field_220 id=field_220_option_1 value="No" checked /><label for="field_220_option_1">No</label><input type=radio name=field_220 id=field_220_option_2 value="Yes" /><label for="field_220_option_2">Yes</label></span></li>
 
						<br>
					Industrial Vehicle Mechanic</label><span><input type=radio name=field_221 id=field_221_option_1 value="No" checked /><label for="field_221_option_3">No</label><input type=radio name=field_221 id=field_221_option_2 value="Yes" /><label for="field_221_option_4">Yes</label></span></li>
 
						<br>
					Maintenance Welder</label><span><input type=radio name=field_222 id=field_222_option_1 value="No" checked /><label for="field_222_option_1">No</label><input type=radio name=field_222 id=field_222_option_2 value="Yes" /><label for="field_222_option_2">Yes</label></span></li><id="fieldBox_20"><span><label class="" for="field_124_option_6"><br>
&nbsp;</label></span></p></td>
						<td width="378" height="564">
						<p style="margin-top: 0px; margin-bottom: 0px"><u><b>Shipping &amp; Stock<br>
						</b></u>Export Shipper</label><span><input type=radio name=field_223 id=field_223_option_1 value="No" checked /><label for="field_223_option_1">No</label><input type=radio name=field_223 id=field_223_option_2 value="Yes" /><label for="field_223_option_2">Yes</label></span></li>
 
						<br>
					Forklift Driver</label><span><input type=radio name=field_224 id=field_224_option_1 value="No" checked /><label for="field_224_option_1">No</label><input type=radio name=field_224 id=field_224_option_2 value="Yes" /><label for="field_224_option_2">Yes</label></span></li>
 
						<br>
 
					Order Packer</label><span><input type=radio name=field_225 id=field_225_option_1 value="No" checked /><label for="field_225_option_3">No</label><input type=radio name=field_225 id=field_225_option_2 value="Yes" /><label for="field_225_option_4">Yes</label></span></li>
 
						<br>
					Shipping Stock Handler</label><span><input type=radio name=field_226 id=field_226_option_1 value="No" checked /><label for="field_226_option_1">No</label><input type=radio name=field_226 id=field_226_option_2 value="Yes" /><label for="field_226_option_2">Yes</label></span></li>
 
						<br>
					Truck Driver (CDL)</label><span><input type=radio name=field_227 id=field_227_option_1 value="No" checked /><label for="field_227_option_1">No</label><input type=radio name=field_227 id=field_227_option_2 value="Yes" /><label for="field_227_option_2">Yes</label></span></li></p>
						<p style="margin-top: 0px; margin-bottom: 0px">
						<u><b>Clerical &amp; 
						Technical</b></u><br>
					Freight Claims</label><span><input type=radio name=field_228 id=field_228_option_1 value="No" checked /><label for="field_228_option_1">No</label><input type=radio name=field_228 id=field_228_option_2 value="Yes" /><label for="field_228_option_2">Yes</label></span></li>
 
						<br>
					Air Conditioning Technician</label><span><input type=radio name=field_229 id=field_229_option_1 value="No" checked /><label for="field_229_option_1">No</label><input type=radio name=field_229 id=field_229_option_2 value="Yes" /><label for="field_229_option_2">Yes</label></span></li>
 
						<br>
					Executive Secretary</label><span><input type=radio name=field_230 id=field_230_option_1 value="No" checked /><label for="field_230_option_1">No</label><input type=radio name=field_230 id=field_230_option_2 value="Yes" /><label for="field_230_option_2">Yes</label></span></li>
 
						<br>
					Manufacturing Records</label><span><input type=radio name=field_231 id=field_35_option_1 value="No" checked /><label for="field_35_option_1">No</label><input type=radio name=field_231 id=field_231_option_2 value="Yes" /><label for="field_231_option_2">Yes</label></span></li>
 
						<br>
					Payroll</label><span><input type=radio name=field_232 id=field_232_option_1 value="No" checked /><label for="field_232_option_1">No</label><input type=radio name=field_232 id=field_232_option_2 value="Yes" /><label for="field_232_option_2">Yes</label></span></li>
 
						<br>
					Scheduling/Expediting</label><span><input type=radio name=field_233 id=field_233_option_1 value="No" checked /><label for="field_233_option_1">No</label><input type=radio name=field_233 id=field_233_option_2 value="Yes" /><label for="field_233_option_2">Yes</label></span></li>
 
						<br>
					Computer Operator</label><span><input type=radio name=field_234 id=field_234_option_1 value="No" checked /><label for="field_234_option_1">No</label><input type=radio name=field_234 id=field_234_option_2 value="Yes" /><label for="field_234_option_2">Yes</label></span></li>
 
						<br>
					Personnel Records</label><span><input type=radio name=field_235 id=field_235_option_1 value="No" checked /><label for="field_235_option_1">No</label><input type=radio name=field_235 id=field_235_option_2 value="Yes" /><label for="field_235_option_2">Yes</label></span></li>
 
						<br>
					Model Making</label><span><input type=radio name=field_236 id=field_236_option_1 value="No" checked /><label for="field_236_option_1">No</label><input type=radio name=field_236 id=field_236_option_2 value="Yes" /><label for="field_236_option_2">Yes</label></span></li>
 
						<br>
					Design Drafting</label><span><input type=radio name=field_237 id=field_237_option_1 value="No" checked /><label for="field_237_option_1">No</label><input type=radio name=field_237 id=field_237_option_2 value="Yes" /><label for="field_237_option_2">Yes</label></span></li>
 
						<br>
					Tool Designing</label><span><input type=radio name=field_238 id=field_238_option_1 value="No" checked /><label for="field_238_option_1">No</label><input type=radio name=field_238 id=field_238_option_2 value="Yes" /><label for="field_238_option_2">Yes</label></span></li>
 
						<br>
					Blueprints</label><span><input type=radio name=field_239 id=field_239_option_1 value="No" checked /><label for="field_239_option_1">No</label><input type=radio name=field_239 id=field_239_option_2 value="Yes" /><label for="field_239_option_2">Yes</label></span></li>
 
						<br>
					Accounts Payable</label><span><input type=radio name=field_240 id=field_240_option_1 value="No" checked /><label for="field_240_option_1">No</label><input type=radio name=field_240 id=field_240_option_2 value="Yes" /><label for="field_240_option_2">Yes</label></span></li>
 
						<br>
					Accounts Receivable</label><span><input type=radio name=field_241 id=field_241_option_1 value="No" checked /><label for="field_241_option_1">No</label><input type=radio name=field_241 id=field_241_option_2 value="Yes" /><label for="field_241_option_2">Yes</label></span></li>
 
						<br>
					Credit</label><span><input type=radio name=field_242 id=field_242_option_1 value="No" checked /><label for="field_242_option_1">No</label><input type=radio name=field_242 id=field_242_option_2 value="Yes" /><label for="field_242_option_2">Yes</label></span></li>
 
						<br>
					Customer Service</label><span><input type=radio name=field_243 id=field_243_option_1 value="No" checked /><label for="field_243_option_1">No</label><input type=radio name=field_243 id=field_243_option_2 value="Yes" /><label for="field_243_option_2">Yes</label></span></li>
 
						<br>
					Exports/Imports</label><span><input type=radio name=field_244 id=field_244_option_1 value="No" checked /><label for="field_244_option_1">No</label><input type=radio name=field_244 id=field_244_option_2 value="Yes" /><label for="field_244_option_2">Yes</label></span></li>
 
						<br>
					Stock Records</label><span><input type=radio name=field_245 id=field_245_option_1 value="No" checked /><label for="field_245_option_1">No</label><input type=radio name=field_245 id=field_245_option_2 value="Yes" /><label for="field_245_option_2">Yes</label></span></li>
 
						<br>
 
					Inventory Control</label><span><input type=radio name=field_246 id=field_246_option_1 value="No" checked /><label for="field_246_option_1">No</label><input type=radio name=field_246 id=field_246_option_2 value="Yes" /><label for="field_246_option_2">Yes</label></span></li>
 
						<br>
					Cad Operator</label><span><input type=radio name=field_247 id=field_247_option_1 value="No" checked /><label for="field_247_option_1">No</label><input type=radio name=field_247 id=field_247_option_2 value="Yes" /><label for="field_247_option_2">Yes<br>
						</label></span>Purchasing</label><span><input type=radio name=field_248 id=field_248_option_1 value="No" checked /><label for="field_248_option_1">No</label><input type=radio name=field_248 id=field_248_option_2 value="Yes" /><label for="field_248_option_2">Yes</label></span></li><span><label class="" for="field_126_option_19"><br>
&nbsp;</label></span></td>
					</tr>
					<tr>
						<td width="719" height="18" colspan="2">&nbsp;<p style="margin-top: 0px; margin-bottom: 0px"><u><b>
						Clerical &amp;Technical<br>
						</b></u>
 
				<id="fieldBox_58">
					Typing</label><span><input type=radio name=field_256 id=field_256_option_1 value="No" checked /><label for="field_58_option_1">No</label><input type=radio name=field_256 id=field_256_option_2 value="Yes" /><label for="field_58_option_2">Yes</label></span></li>&nbsp;
					WPM</label><input type=text name=field_128 id=field_128 size='14' value=''>&nbsp;
						<br>
					Calculator/10 Key Adding Machine</label><span><input type=radio name=field_264 id=field_264_option_1 value="No" checked /><label for="field_66_option_1">No</label><input type=radio name=field_264 id=field_264_option_2 value="Yes" /><label for="field_66_option_2">Yes</label></span><id="fieldBox_58"><br>
						<span><br>
						</span>
 
				<id="fieldBox_59">
					Word Processing</label><span><input type=radio name=field_257 id=field_257_option_1 value="No" checked /><label for="field_59_option_1">No</label><input type=radio name=field_257 id=field_257_option_2 value="Yes" /><label for="field_59_option_2">Yes</label></span><br>
						Please list systems used:</label><input type=text name=field_131 id=field_131 size='74' value=''><br>
						<id="fieldBox_60">
						<span>
						<label class="" for="field_134_option_1"><br>
						</label></span>
 
				<id="fieldBox_61">
					PC</label><span><input type=radio name=field_259 id=field_259_option_1 value="No" checked /><label for="field_61_option_1">No</label><input type=radio name=field_259 id=field_259_option_2 value="Yes" /><label for="field_61_option_2">Yes</label><label class="" for="field_134_option_1"><br>
						</label></span>Please list software used:</label><input type=text name=field_135 id=field_135 size='73' value=''><br>
						<id="fieldBox_66">
						</li>
 
				&nbsp;<id="fieldBox_68"></p>
						<p style="margin-top: 0px; margin-bottom: 0px">
					<u><b>What are your work 
					interests?</b></u><br>
						</label>
						<textarea  name=field_140 id=field_140 rows=4 cols=81></textarea></td>
					</tr>
				</table>
				<p style="margin-top: 0px; margin-bottom: 0px">
				<table width="734">		
		<tr>
		<td bgcolor="#336601" width="724">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>Other 
		Information</b></font></td>
	</tr>
</table>
				<table cellpadding="0" cellspacing="0" width="718" height="241">
					<!-- MSTableType="nolayout" -->
					<tr>
						<td width="718" height="241" valign="top">
					<p style="margin-top: 0px; margin-bottom: 0px">When is the best time to 
					call you at home?</label><input type=text name=field_141 id=field_141 size='33' value=''><br>
					<br>
					May we contact you at work?</label><span><input type=radio name=field_142 id=field_142_option_1 value="Yes" /><label class="" for="field_142_option_1">Yes</label><input type=radio name=field_142 id=field_142_option_2 value="No" /><label class="" for="field_142_option_2">No&nbsp; </label></span>
					&nbsp; If yes, when is the 
					best time to call?</label><input type=text name=field_143 id=field_143 size='20' value=''><br>
					If yes, what is your work 
					telephone number?</label><input type=phone name=field_144 id=field_144 size=20 value="" style="background-image:url(imgs/phone.png); background-repeat: no-repeat;  padding: 2px 2px 2px 25px;"><br>
					<br>
					Who should we call in case 
					of emergency?&nbsp;</label><input type=text name=field_145 id=field_145 size='20' value=''>
					<i>Enter full name</i><br>
					Emergency Contact Phone number<input type=phone name=field_146 id=field_146 size=20 value="" style="background-image:url(imgs/phone.png); background-repeat: no-repeat;  padding: 2px 2px 2px 25px;"><br>
					<br>
					List any additional 
					information you would like us to consider:<br>
						</label>
						<textarea  name=field_147 id=field_147 rows=5 cols=82></textarea><br>
&nbsp;</td>
					</tr>
				</table>
				<p style="margin-top: 0px; margin-bottom: 0px">
				</p>
				<p style="margin-top: 0px; margin-bottom: 0px" align="right">
				<table width="732">		
		<tr>
		<td bgcolor="#336601" width="354">
		<p style="margin-top: 0px; margin-bottom: 0px">
		<img src="imgs/spacer.gif" alt="" width="19" border="0" height="20"><font color="#FFFFFF"><b>Agreement</b></font></td>
		<td bgcolor="#336601" width="368">
		<p align="right"><font color="#FFFFFF"><b>READ CAREFULLY BEFORE SIGNING</b></font></td>
	</tr>
</table></div>
			<p class="MsoPlainText">In signing and submitting this application 
			for employment to you (the Company), I clearly understand and agree:</p>
			<p class="MsoPlainText">&nbsp; &nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp; I certify that the information 
			contained in this application is correct and complete to the best of 
			my knowledge and understand that any omission, misrepresentation or 
			falsification of information made herein or in any interviews is 
			grounds for refusal to employ me or my dismissal if I am employed;</p>
			<p class="MsoPlainText">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp; I authorize the references 
			listed above, schools and current and past employers to give the 
			Company any and all information concerning my previous employment 
			and any information they may have, personal or otherwise, and I 
			release all parties from all liability for any damage or claim that 
			may result from furnishing the same to the Company;</p>
			<p class="MsoPlainText">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp; If I am employed, I agree to 
			abide by the rules, regulations and policies of the Company, and my 
			employment and compensation can be terminated, with or without 
			cause, and with or without notice, at any time, at the option of 
			either the Company or myself;</p>
			<p class="MsoPlainText">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp; I understand that no 
			representative of the Company, other than the President of the 
			Company, has any authority to enter into any agreement for 
			employment for any specified period of time, or make any agreement 
			contrary to the foregoing.<br>
&nbsp;</p>
			<p style="margin-top: 0px; margin-bottom: 0px">Signature&nbsp;*&nbsp;</label><input type=text name=field_148 id=field_148 size='20' value=''></li>
		
		
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